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发展缓和医疗理念和实践后终末期患者死亡状况变化

Changes in the Death Status of End-of-life Patients After Concept Promotion and Practice of Palliative Care

    摘要
  • 摘要:
      目的  北京协和医院国际医疗部于2016年开始逐步推行缓和医疗理念和实践，本研究旨在对该理念推广前后终末期患者死亡状况进行分析，以评估缓和医疗对终末期患者死亡质量的影响。
      方法  回顾性收集北京协和医院国际医疗部2013年和2019年死亡的终末期患者的临床资料，对其临终前诊疗细节进行比较。
      结果  共入选符合纳入与排除标准的2013年终末期患者36例、2019年终末期患者37例。2013年患者中，男性19例、女性17例，平均年龄(72.1±14.0)岁，晚期肿瘤19例。2019年患者中，男性19例、女性18例，平均年龄(70.8±15.3)岁，晚期肿瘤27例。相较于2013年患者，2019年患者临终前转入ICU(0比22.2%，P=0.008)、接受心肺复苏(0比16.7%，P=0.011)、气管插管(5.4%比36.1%，P=0.001)、有创机械通气(2.7%比33.3%，P=0.001)、全肠外营养(32.4%比61.1%，P=0.014)的比例均降低，接受缓和医疗会诊(29.7%比0，P<0.001)、得到人文关怀(40.5%比16.7%，P=0.024)的比例均升高。2019年患者中，相较于未接受缓和医疗会诊患者，接受缓和医疗会诊者得到人文关怀的比例更高(90.9%比19.2%，P<0.001)。
      结论  缓和医疗理念推广和实践后北京协和医院国际医疗部终末期患者死亡前接受有创治疗的比例明显降低，得到人文关怀的比例显著提高，死亡质量得到一定提升。

     

    Abstract:
      Objective  The International Medical Services Department of Peking Union Medical College Hospital (PUMCH) has gradually promoted the concept and practice of palliative care since 2016. This study aims to analyze the death status of end-of-life patients before and after the promotion endeavor, in order to evaluate the impact of palliative care on the death quality.
      Methods  All clinical data from end-of-life patients who died at the International Medical Services Department of PUMCH in 2013 and 2019 were retrospectively collected, and their diagnosis and treatment details before death were compared.
      Results  A total of 36 end-of-life patients who died in 2013 and 37 end-of-life patients who died in 2019 met the inclusion and exclusion criteria. In 2013, there were 19 males and 17 females, with an average age of (72.1±14.0) years, and 19 cases had advanced cancer. In 2019, there were 19 males and 18 females, with an average age of (70.8±15.3) years, and 27 cases had advanced cancer. Compared to patients who died in 2013, a lower proportion of the patients in 2019 who were transferred to the ICU before death(0 vs. 22.2%, P=0.008), received cardiopulmonary resuscitation (0 vs. 16.7%, P=0.011), had tracheal intubation(5.4% vs. 36.1%, P=0.001), invasive mechanical ventilation(2.7% vs. 33.3%, P=0.001), and total parenteral nutrition(32.4% vs. 61.1%, P=0.014), while a higher proportion received palliative care consultations(29.7% vs. 0, P<0.001), and humanistic care(40.5% vs. 16.7%, P=0.024). In 2019, compared to the patients who did not receive palliative care consultations, those who received palliative care consultations had a higher proportion of humanistic care(90.9% vs. 19.2%, P<0.001).
      Conclusions  After concept promotion and practice of palliative care, the proportion of end-of-life patients receiving invasive treatments before death in the International Medical Services Department of PUMCH has significantly decreased, the proportion receiving humanistic care has significantly increased, and the quality of death has been improved to a certain extent.

     

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