Swetz Keith M, Ottenberg Abigale L, Freeman Monica R, Mueller Paul S
Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Curr Heart Fail Rep. 2011 Sep;8(3):212-8. doi: 10.1007/s11897-011-0060-x.
Left ventricular assist devices as destination therapy (DT) improve quality of life for many patients with advanced heart failure. However, DT can be associated with risks such as infection, bleeding, and stroke, and may impose psychosocial strain on patients and caregivers. Furthermore, patients treated with DT eventually will die with their device in place whether death is related to the device or not. In response to these concerns, palliative medicine consultation has been suggested with standard DT care to improve focus on quality of life, symptom management, and end-of-life planning. This article reviews key issues associated with caring for patients with DT, including psychosocial, quality-of-life, caregiving, and ethical issues, and discusses end-of-life management of patients with DT, including practical considerations, but moreover, review topics regarding communication, symptom management, and provision of appropriate comfort care.
作为终末期治疗（DT）的左心室辅助装置可改善许多晚期心力衰竭患者的生活质量。然而，终末期治疗可能会带来感染、出血和中风等风险，并且可能给患者及其护理人员带来心理社会压力。此外，接受终末期治疗的患者最终无论死亡是否与装置相关，都会带着装置离世。针对这些担忧，有人建议在标准终末期治疗中加入姑息医学咨询，以更好地关注生活质量、症状管理和临终规划。本文回顾了与终末期治疗患者护理相关的关键问题，包括心理社会、生活质量、护理和伦理问题，并讨论了终末期治疗患者的临终管理，包括实际考量，此外，还回顾了关于沟通、症状管理和提供适当舒适护理的主题。
