姑息治疗住院单元在癌症和艾滋病患者疾病管理中的作用。

Settlers Hospital, Grahamstown, E Cape, South Africa.

S Afr Med J. 2007 Sep;97(9):849-52.

OBJECTIVES

To monitor the success of an inpatient palliative care unit combining private and state patients, and accessible to patients with cancer and AIDS.

DESIGN

An observational study was conducted of patients admitted to the unit in the first 3 months following opening of the ward (1 March - 31 May 2006).

METHODS

Data were collected on all patients admitted to the ward to establish patient profiles, duration of stay and outcome of palliative care.

RESULTS

In the first 3 months 51 patients were admitted. Of these patients, 36 (70%) (1 readmission) had AIDS. All the AIDS patients had stage 4 disease and all but 3 were on antiretroviral (ARV) treatment. The death rate in the initial 3 months was 38% in the cancer group and 33% in the AIDS group. By the end of the 5th month the death rate was 37.5% in the cancer group, and 27% in the AIDS group. The remainder of the patients were discharged. The average duration of stay in the ward was 8.3 days. Among those who died, the average stay was 3.8 days for cancer patients and 8.3 days for AIDS patients. Among the patients who were discharged, the average duration of stay was 7 days for cancer patients and 8.5 days for AIDS patients.

CONCLUSIONS

The profile of terminally ill patients with cancer and AIDS was initially similar in terms of death rate. In the first 3 months 38% of cancer patients and 33% of AIDS patients died. In the following 2 months the death rate was 33% for cancer patients and 19% for AIDS patients. While the numbers of patients are small and only an indication of trend, the AIDS death rate seems to be dropping. This may be because ARV treatment is being introduced earlier, or because the role of palliative care in the treatment of AIDS patients is gaining recognition and introduction of this form of treatment is having a beneficial effect on outcome. In this hospital it is now accepted that AIDS patients developing symptoms on treatment will benefit from admission to a palliative care ward. This intervention may well improve the outcome in stage 4 AIDS. The duration of stay in the ward is longer for AIDS patients, and it appears that AIDS patients who survive will need a longer stay in the palliative care unit than cancer patients if outcome is to improve.

目的

监测一家收治私立和公立患者、可供癌症患者及艾滋病患者使用的住院姑息治疗病房的成效。

设计

对该病房开放后头3个月（2006年3月1日至5月31日）收治的患者进行了一项观察性研究。

方法

收集了所有入住该病房患者的数据，以建立患者档案、住院时间及姑息治疗结果。

结果

头3个月有51名患者入院。其中36名（70%）（1名再次入院）患有艾滋病。所有艾滋病患者均处于4期疾病，除3名外均接受抗逆转录病毒（ARV）治疗。癌症组最初3个月的死亡率为38%，艾滋病组为33%。到第5个月末，癌症组死亡率为37.5%，艾滋病组为27%。其余患者出院。病房平均住院时间为8.3天。死亡患者中，癌症患者平均住院3.8天，艾滋病患者平均住院8.3天。出院患者中，癌症患者平均住院时间为7天，艾滋病患者为8.5天。

结论

晚期癌症患者和艾滋病患者的概况在死亡率方面最初相似。头3个月，38%的癌症患者和33%的艾滋病患者死亡。在接下来的2个月里，癌症患者死亡率为33%，艾滋病患者为19%。虽然患者数量较少，仅能表明趋势，但艾滋病死亡率似乎在下降。这可能是因为抗逆转录病毒治疗更早引入，或者是因为姑息治疗在艾滋病患者治疗中的作用得到认可，这种治疗方式的引入对结果产生了有益影响。在这家医院，现在认为正在接受治疗且出现症状的艾滋病患者将从入住姑息治疗病房中获益。这种干预很可能会改善4期艾滋病的治疗结果。艾滋病患者在病房的住院时间更长，而且如果要改善治疗结果，似乎存活的艾滋病患者比癌症患者需要在姑息治疗病房停留更长时间。