急诊重症监护室临终医疗实施现状调查

发布时间：2019-04-10 14:04

【摘要】：目的:明确急诊重症监护室临终医疗实施的情况,同时了解急诊重症监护室对危重症患者人文方面的实施情况,发现目前存在的问题,并提出相应的指南或解决策略,引起对急危重症患者人文关怀的重视。方法:对2015年11月-2016年10月到我院急诊重症监护室住院患者完成基本信息采集,根据Ethicus II研究提供的问卷完成所有内容,并在24小时内完成APACHE-II评分。根据调查的结果将临终类别分为限制、撤离、限制-撤离、心肺复苏共4组进行数据分析。结果:本研究显示急危重症监护室临终医疗总体发生率为42.3%,以实施撤离治疗为主。以EICU常见病、多发病为主。患者和医师宗教信仰并没有影响临终医疗的实施。临终医疗实施主体是主管医生和患者家属,家属为主要提出方,主要实施原因是慢性疾病。内容主要是肠内营养与静脉输液。死亡预后受医保类型和APACHE II评分影响。结论:不同的ICU、国家、地区其临终医疗的实施存在较大差异;宗教信仰并没有影响临终医疗的实施;经济因素是影响患者死亡预后的重要因素。临终医疗实施上发现有患者意愿不足、护士参与程度低等问题。利用循证医学的方法可以更有效与家属沟通,提升临终医疗实施质量。
[Abstract]:Objective: To clarify the situation of the end-of-life medical treatment of the emergency intensive care unit, and to know the implementation of the emergency intensive care unit in the humanistic aspects of the critically ill patients, and to find out the existing problems and to put forward the corresponding guidance or solution. And the attention of the humanistic care of the acute and severe patients is caused. Methods: The basic information was collected from November 2015 to October,2016, and all the contents were completed according to the questionnaire provided by the Ethicon II study, and the APACHE-II score was completed within 24 hours. According to the results of the survey, the end-of-life category was divided into four groups: restriction, withdrawal, restriction-evacuation, and cardiopulmonary resuscitation. Results: The overall incidence of the end-of-life medical treatment in the intensive care unit was 42.3%. It is a common disease in the intensive care unit (EICU). The patient and physician's religious beliefs do not affect the implementation of the end-of-life medical treatment. The main body of the end-of-life medical implement is the chief physician and the family of the patient, the family is the main sponsor, the main reason is the chronic disease. The main contents are enteral nutrition and intravenous infusion. The prognosis of death was affected by the medical insurance type and the APACHE II score. Conclusion: There is a great difference in the implementation of the end-of-the-life medical treatment in the different ICU, the country and the region; the religious belief does not affect the implementation of the last medical treatment; the economic factors are the important factors that affect the prognosis of the patient's death. In the end-of-the-life medical practice, it is found that the patient's will is insufficient, the degree of participation of the nurse is low. The method of using evidence-based medicine can communicate with the family more effectively and improve the quality of the end-of-life medical implementation.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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