重症肿瘤患者放弃治疗的影响因素分析

Analysis of withholding and/or withdrawing treatment in the critically ill cancer patients

目的：统计重症肿瘤患者放弃治疗的现状，分析放弃治疗决策的影响因素。方法：对2010年1月1日～2011年12月31日入住中山大学肿瘤防治中心ICU接受重症支持治疗并有完整病例资料记录的肿瘤患者进行回顾性研究，收集其相关临床资料并分析放弃治疗的现状及影响因素。结果：纳入研究共有347例次，其中放弃治疗组82例次（23.6%），持续治疗组265例次（76.4%）；经单因素及多因素分析筛出重症肿瘤患者放弃治疗的高危因素为家庭经济困难、人文关怀需求、ICU内合并MODS/MOF和急诊或病危入院。结论：经济条件差、人文传统需求、病情进展及起病危急状态是重症肿瘤患者放弃治疗决策的高危因素，肿瘤患者放弃治疗的决策与我国医疗体制、医疗卫生资源及文化传统等国情有一定关系。

To investigate the clinical factors of the withholding/withdrawing treatment in the critically ill cancer patients. Methods: Clinical records of 347 patients from 2010.1.1 to 2011.12.31 in our Cancer Center were collected and retrospectively analyze. These data were divided into the withholding/withdrawing treatment group and the normal treatment group, then investigate the clinical characters of the withholding/withdrawing treatment in the critically ill cancer patients. Results: 347 cases were investigated in the study, 82 cases (23.6%) chosen to withhold or withdraw treatment, including 64 men and 18 women.265 cases ( 76.4%)to carryon the treatment. Multivariate logistic regression analyses indicated that the poor economic status, care needs, poor admission status and MODS/MOF in ICU were significant predictors for the withholding and/or withdrawing treatment in the critically ill cancer patients. Conclusion: The poor economic status, care needs, progression of the disease and poor admission status were considered as the main risk factors of the withholding and/or withdrawing treatment in the critically ill cancer patients. Decisionsabout the withholding and/or withdrawing treatment in the critically ill cancer patients have something with our national actual conditions, for example Chinese health care system, health care resources and our cultural custom.