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題 名 | 重度慢性阻塞性肺疾患者的緩和呼吸照護=Palliative Respiratory Care for Patients with Severe Chronic Obstructive Pulmonary Disease |
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作 者 | 呂碧瑛; 陳美黛; 陳明仁; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 9:1 2010.01[民99.01] |
頁 次 | 頁53-62 |
分類號 | 419.77 |
關鍵詞 | 緩和照護; 慢性阻塞性肺疾; 臨終照護; 呼吸照護; Palliative care; Chronic obstructive pulmonary disease; End-of-life care; Respiratory care; |
語 文 | 中文(Chinese) |
中文摘要 | 目前慢性阻塞性肺疾病(chronic obstructive pulmonary; COPD)爲全球性第四大的死亡原因,預估於西元2020年前,將成爲全球第三大的死亡原因。主要特徵爲不可逆且具漸進性的肺疾病,容易合併其他疾病(心血管疾病、癌症、肺部感染、體重減輕、肌肉萎縮、骨質疏鬆、糖尿病、憂鬱症),相對地增加死亡率。其末期的症狀通常比肺癌來得嚴重與痛苦,造成身體功能降低、生活品質低落、對他人或醫療系統的依賴度增加。過去,緩和醫學一直以癌末病人爲重心,長期忽略末期COPD病人的緩和照護需求,相關的專業組織與機構陸續發表聲明,呼籲大眾正視這些病人的緩和照護。然而,臨床發現,COPD病人接受過多的侵入性醫療、多半死於加護病房中、死前承受過多的不適症狀、接受較少的緩和醫療服務。推動上仍存在許多的障礙包括:(1) COPD具高度不確定性,目前醫學仍難已準確掌握該病程、病人與家屬對COPD的生命威脅性認知落差。(2)不同於癌症,COPD的急性發作(acute exacerbation)和無法治癒性,延誤支持療法介入的時機。(3)病人對接受治療的選擇認知不足。(4)醫療人員對緩和照護訓練不足。將癌症緩和照護的推廣經驗,解決現存COPD緩和照護的障礙。醫療人員應了解疾病預後的不確定性並面對上述阻礙,針對末期COPD病人的需求,發展出以提高生活品質爲中心的緩和醫學。其中呼吸治療師因工作的專業性和特殊性,更應主動積極加入緩和醫學的團隊中,共同增進病人與家屬於疾病末期時的生活品質、緩和照護與臨終關懷。 |
英文摘要 | It is estimated that chronic obstructive pulmonary disease (COPD) could be the third of globally death causes by the year of 2020. In Europe and the United States, the deaths of COPD patients greatly increase year by year. Near the end of life, patients with severe COPD have suffered from more distress, such as dyspnea, pain, depression and anxiety, compared to these with malignant cancer. Comfortable care will be an important issue. However, the concept and quality about palliative care in patients with COPD are inadequate and less than those with terminal cancer. The reasons include (1) poor prediction of disease prognosis, (2) lack of acknowledge, (3) familiarity on the palliative care and, (4) insufficient education program. To overcome these barriers, the health care provides should pay more attentions in these issues, set up new decision-making way and early initiation of the end of life discussion. RTs (respiratory therapist) should be able to play more active role in palliative respiratory care, particularly severe COPD, than other health providers. They have better knowledge and enough communication on respiratory care to meet the patient's demands of relieving dyspnea, such as oxygen therapy, bronchodilators administration, suctioning, pulmonary rehabilitation, non-invasive ventilation support. By having multidisciplinary team work, the patients at end-stage of COPD will receive a higher quality of palliative care service. |
本系統中英文摘要資訊取自各篇刊載內容。