摘要
目的了解老年医学科因癌与非癌死亡患者的临床特点、心肺复苏意愿以及生命末期医疗状况的异同,为不同老年人群开展缓和医疗工作提供依据。方法回顾性分析,连续查阅2014~2017年我院老年医学科≥60岁患者的死亡病历,记录临床特征、心肺复苏(CPR)签署、维持生命手段的应用及临终前医疗状况,129例根据死亡原因分为因癌死亡组(48例)和非癌死亡组(81例),比较组间临床特点及末期医疗状况的差异。结果共129例患者,男性98例(76.0%),女性31例(24.0%),中位年龄87(60~100)岁,≥80岁110例(85.3%)。死亡原因主要为恶性实体肿瘤(48例,37.2%)和感染性疾病(47例,36.4%)。与因癌死亡组患者(48例)比较,非癌死亡组患者(81例)中≥80岁的比例高(P<0.05),95.1%(77例)比68.7%(33例);镇痛药物的使用率[5.0%(4例)比29.2%(14例)]和查尔森共病指数(5.7±2.3比8.9±2.7)降低(P<0.01);入住重症监护室(ICU)、中重度失能、口服多重用药的比例差异无统计学意义(P>0.05);入院当日完成签署CPR意愿的比例70.9%(56例)比39.6%(19例)、呼吸机使用率38.3%(38例)比16.7%(8例)、呼吸兴奋剂的使用率71.6%(58例)比52.1%(25例)增高(P<0.05);不同意CPR、行心外按压、电除颤、气管切开、气管插管的比例和血管活性药物的使用率比较,差异无统计学意义(均P>0.05)。结论老年医学科生命末期患者情况复杂、终末期医疗负担重,急需开展老年缓和医疗;除了关注癌症患者外,非癌疾病终末期包括症状控制、早期探讨预先医疗计划、避免过度应用维生手段亦是需要重点关注的问题。
Objective To investigate the clinical characteristics,preferences for cardiopulmonary resuscitation(CPR)and end-of-life care status in elderly patients with cancer vs.non-cancer diseases under geriatric care,and to provide the basis for different elderly groups to carry out palliative care.Methods Medical records of deceased residents aged≥60 years from 2014 to 2017 in the department of geriatrics of our hospital were retrospectively reviewed.Data on clinical characteristics,preferences for CPR,application of life-sustaining treatments and end-of-life care were collected.A total of 129 patients were divided into the cancer death group(n=48)and the non-cancer death group(n=81)according to the cause of death.Clinical characteristics and end-of-life care status were compared between the two groups.Results A total of 129 cases including 98 males(76.0%)and 31 females(24.0%),with a median age of 87(60~100)years and 110 cases(85.3%)aged 80 years and above,were enrolled in this study.The main causes of death were malignant solid tumors(48 cases,37.2%)and infectious diseases(47 cases,36.4%).Compared with the cancer death group(n=48),the proportion of patients aged 80 years and above was higher(n=81)(95.1%or 77 cases vs.68.7%or 33 cases),the proportion of painkiller utilization(5.0%or 4 cases vs.29.2%or 14 cases)and Charlson Comorbidity Index scores(5.7±2.3 vs.8.9±2.7)were lower in the non-cancer death group(P<0.01).There was no difference in proportions admitted to the intensive care unit,with moderate and severe disability,or with polypharmacy between the two groups(P>0.05).Compared with the cancer death group,the proportions opting for CPR on admission day(70.9%or 56 cases vs.39.6%or 19 cases),administration of ventilators(38.3%or 38 cases vs.16.7%or 8 cases)and respiratory stimulants(71.6%or 58 cases vs.52.1%or 25 cases)were higher in the non-cancer death group(P<0.05).There was no difference in preference for do-not-resuscitate(DNR),utilization of extracardiac compression,electrical defibrillation,tracheotomy,trac
作者
刘谦
周健
秦明照
侯银静
郑辉
Liu Qian;Zhou Jian;Qin Mingzhao;Hou Yinjing;Zheng Hui(Department of Geriatrics,Beijing Tongren Hospital,Affiliated to Capital Medical University,Beijing 100730,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第5期573-577,共5页
Chinese Journal of Geriatrics
关键词
生命支持疗法
缓和医疗
癌
Life support care
Palliative Care
Carcinoma
