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.
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 pa-tients who died at the International Medical Services Department of PUMCH in 2013 and 2019 were retrospec-tively 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 ex-clusion 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 pro-portion receiving humanistic care has significantly increased,and the quality of death has been improved to a certain extent.