Janssen van Doorn K, Diltoer M, Spapen H
Dienst Intensieve Geneeskunde, Universitair Ziekenhuis, Vrije Universiteit Brussel, Belgium.
Acta Clin Belg. 2008 Jul-Aug;63(4):221-6. doi: 10.1179/acb.2008.041.
We examined the process, consequences and impact of writing a Do-Not-Resuscitate (DNR) order in a cohort of critically-ill ICU patients. Special emphasis was given to the DNR order including withholding renal replacement therapy. A DNR code was mainly written in the first week following ICU admission and more often given to medical, older and sicker patients. Patients never actively participated in the decision and in only half of the cases the DNR order was discussed with relatives. Mortality of all patients studied was 21% of whom 67% died with a DNR order. In our population, the final in-hospital mortality rate of DNR-coded patients was 100%, because the DNR status was ordered when the patients were already very sick. DNR-coded patients died after a longer mean length of ICU stay than patients without a code. Withholding renal replacement therapy was commonly added to the DNR order even if renal failure either was not present or never developed.
我们研究了一组重症监护病房（ICU）危重病患者下达“不要复苏”（DNR）医嘱的过程、后果及影响。特别强调了包括停止肾脏替代治疗在内的DNR医嘱。DNR医嘱主要在入住ICU后的第一周开出，更多是针对内科患者、老年患者及病情较重的患者。患者从未积极参与决策，只有半数病例与亲属讨论过DNR医嘱。所有研究患者的死亡率为21%，其中67%在有DNR医嘱的情况下死亡。在我们的研究人群中，有DNR编码患者的最终院内死亡率为100%，因为DNR状态是在患者病情已经非常严重时下达的。有DNR编码的患者在ICU的平均住院时间比无编码的患者更长。即使不存在肾衰竭或肾衰竭从未发生，停止肾脏替代治疗也通常会被添加到DNR医嘱中。
