Steen Petter Andreas, Dye Joakim, Mjåland Odd
Kirurgisk divisjon, Ullevål universitetssykehus, 0407 Oslo.
Tidsskr Nor Laegeforen. 2003 Nov 20;123(22):3201-2.
A previous publication indicates a lack of clear guidelines for DNAR orders in Norwegian hospitals. The Norwegian Board of Health has recently published strict requirements for such a procedure.
Patients discharged from a surgical department from 1 March to 31 May 2001 with complicated or advanced cancer and/or a postoperative stay of minimum ten days. The patient files were studied for information on DNAR orders and/or cardiac arrest.
13 out of 69 patients had a DNAR order. In eight of them there was either no explanatory note in the files or no correct signature. Three of the five other patients had taken part in the discussion, so had next-of-kin in two circumstances. Resuscitation was not initiated in any of 14 patients with cardiac arrest. Six of these, who had no DNAR order, all had advanced, inoperable cancer or serious chronic cardiac and respiratory failure. There were no signs that a DNAR order had influenced any other treatment decision.
The department had a clear procedure for writing DNAR orders but it was followed in less than half of the cases.
先前的一份出版物表明，挪威医院在下达“不要进行心肺复苏”（DNAR）医嘱方面缺乏明确的指导方针。挪威卫生委员会最近发布了对此类程序的严格要求。
选取2001年3月1日至5月31日从外科出院的患有复杂或晚期癌症和/或术后住院至少10天的患者。研究患者病历，以获取有关DNAR医嘱和/或心脏骤停的信息。
69名患者中有13名有DNAR医嘱。其中8名患者的病历中要么没有解释说明，要么没有正确签名。其他5名患者中有3名参与了讨论，在两种情况下其近亲也参与了讨论。14名心脏骤停患者中没有一人接受心肺复苏。其中6名没有DNAR医嘱的患者，均患有晚期无法手术的癌症或严重的慢性心脏和呼吸衰竭。没有迹象表明DNAR医嘱影响了任何其他治疗决策。
该科室有明确的下达DNAR医嘱的程序，但不到一半的病例遵循了该程序。
