北京协和医院2019年离世患者缓和医疗实施现状分析

Implementation Status of Palliative Care for Patients Died in Peking Union Medical College Hospital,2019

目的调查北京协和医院住院死亡患者缓和医疗实施现状,为终末期患者的缓和医疗实践提供参考。方法对2019年1月1日至2019年12月31日在北京协和医院住院死亡患者进行回顾性研究,收集住院死亡患者的一般临床资料、住院期间是否接触到缓和医疗及临终前诊治细节,如是否接受有创抢救措施、是否进行症状控制及是否进行心理、社会、灵性照顾等,并进行描述性分析。结果2019年住院总死亡人数244例,其中,男135例,女109例,平均年龄(65.9±16.4)岁(1 d~105岁)。肿瘤性疾病死亡人数112例(45.9%),非肿瘤性疾病死亡人数132例(54.1%)。有61例(25.0%)患者死亡前接触到缓和医疗,大多数分布于内科科室,以肾内科(100.0%)、消化内科(80.0%)、老年医学科(72.7%)为主;29例患者得到完善的缓和医疗照护,症状均得到控制,死亡前均未采用有创救治措施,有26例接受心理、社会、灵性照顾。与未接触到缓和医疗组相比,接触到缓和医疗组的死亡患者心肺复苏(0比20.2%;χ^(2)=13.009,P<0.001)、气管插管(3.3%比48.6%;χ^(2)=38.327,P<0.001)、有创机械通气比例(4.9%比47.5%;χ^(2)=33.895,P<0.001)明显下降,心理、社会及灵性照顾比例明显提高(54.1%比2.4%;χ^(2)=91.486,P<0.001)。结论缓和医疗理念对终末期患者的死亡有正向影响,缓和医疗服务可以使终末期患者更能获得心理、社会、灵性照顾,有创救治的使用明显减少。

Objective To reveal the current situation of palliative care for patients who died in Peking Union Medical College Hospital,so as to guide the practice of palliative care for patients in terminal stage.Methods A retrospective study was conducted on patients who died in Peking Union Medical College Hospital from January 1,2019 to December 31,2019.The general clinical data of the patients,whether they received palliative care,and the treatment details including invasive rescue measures,symptom controlling,and psychological,social,and spiritual care status before dying were collected for descriptive analysis.Results A total of 244 inpatients died in 2019,including 135 males and 109 females,with an average age of(65.9±16.4)years(1 day to 105 years).Among the 244 patients,112(45.9%)died of neoplastic diseases and 132(54.1%)died of non-neoplastic diseases.Sixty-one(25.0%)patients received palliative care before death,and they were mainly distributed in internal medicine departments such as nephrology(100.0%),gastroenterology(80.0%),and geriatrics(72.7%).Twenty-nine patients received sound palliative care,with all symptoms under control and no invasive treatment before death,and twenty-six patients received psychological,social,and spiritual care.Compared with the patients who were not exposed to the concept of palliative care,the patients who received palliative care showed decreased probabilities of cardiopulmonary resuscitation(0 vs 20.2%;χ^(2)=13.009,P<0.001),tracheal intubation(3.3%vs 48.6%;χ^(2)=38.327,P<0.001),and invasive mechanical ventilation(4.9%vs 47.5%;χ^(2)=33.895,P<0.001)and an increased probability of psychological,social,and spiritual care(54.1%vs 2.4%;χ^(2)=91.486,P<0.001).Conclusion The concept of palliative care has a positive impact on the death of end-stage patients.Palliative care services can increase the probability of end-stage patients receiving psychological,social,and spiritual care and reduce the use of invasive treatment.