脑出血患者的不进行心肺复苏医嘱：来自一家中国三级医疗中心的经验

Do not resuscitate orders for patients with intracerebral hemorrhage: experience from a Chinese tertiary care center.

作者信息

Yang Tie-Cheng, Li Jian-Guo, Guo Wei

机构信息

Emergency Department, Beijing Tiantan Hospital, Capital Medical University/Beijing Neurosurgical Institute, China.

出版信息

Eur Neurol. 2015;73(3-4):144-9. doi: 10.1159/000369792. Epub 2015 Jan 6.

DOI:10.1159/000369792

PMID:25573228

Abstract

AIM

This study aimed to determine the frequency and determinant factors of do not resuscitate (DNR) orders in patients with intracerebral hemorrhage (ICH) at a university hospital in China.

METHODS

Data collected from June 2010 to December 2012 for patients with ICH were retrospectively reviewed. The characteristics and care of patients with and without DNR orders and those with early (≤24 h) and late (>24 h) DNR establishment were compared.

RESULTS

Formal DNR orders were filed during hospitalization for 64/759 (8.4%) patients with complete medical records enrolled in this study. Patients with DNR orders were older on average (73.1 ± 10.1 vs. 56.0 ± 13.2 years; p < 0.001) and a larger proportion had pre-ICH comorbidity impacting dependency (87.5 vs. 17.0%; p < 0.001) than did those with no DNR order. Patients with DNR orders were in worse clinical condition on arrival than those without a DNR order, as judged by Glasgow Coma Scale scores, and more frequently had large hematoma volumes (78.1 vs. 39.7%; p < 0.001).

CONCLUSIONS

DNR orders were not used commonly for patients with ICH in this Chinese sample. No relationship between ICH severity and DNR decision making was observed.

摘要

目的

本研究旨在确定中国一家大学医院脑出血（ICH）患者中“不要复苏”（DNR）医嘱的频率及决定因素。

方法

回顾性分析2010年6月至2012年12月收集的ICH患者数据。比较有和没有DNR医嘱的患者以及早期（≤24小时）和晚期（>24小时）确立DNR医嘱的患者的特征及治疗情况。

结果

本研究纳入的759例有完整病历的患者中，64例（8.4%）在住院期间下达了正式的DNR医嘱。有DNR医嘱的患者平均年龄更大（73.1±10.1岁 vs. 56.0±13.2岁；p<0.001），与无DNR医嘱的患者相比，有更多比例的患者在脑出血前存在影响生活自理能力的合并症（87.5% vs. 17.0%；p<0.001）。根据格拉斯哥昏迷量表评分判断，有DNR医嘱的患者入院时临床状况比无DNR医嘱的患者更差，且更常出现血肿体积较大的情况（78.1% vs. 39.7%；p<0.001）。