School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Surgical Intensive Care Unit, National Cheng Kung University Hospital, Tainan, Taiwan.
School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
J Pain Symptom Manage. 2018 Mar;55(3):835-842. doi: 10.1016/j.jpainsymman.2017.11.024. Epub 2017 Nov 27.
Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life and what trends in care are in recent years.
The objective of this study was to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010.
Analysis of claims data of 55,930 patients with stroke obtained from the National Health Insurance Research Database was performed to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010.
Over the whole study period, 25.4% of patients with stroke were admitted to intensive care units in their last month of life. The percentages of patients receiving mechanical ventilation (77.4%-67.9%), cardiopulmonary resuscitation (53.8%-35.8%), and inotropic agents (73.5%-64.3%) decreased over time. The percentages of patients receiving artificial hydration and nutrition (65.9%-73.3%) and sedative or analgesic agents (34.7%-38.6%) increased over time. Patients under 85 years old were more likely to be admitted to intensive care units. Men were more likely to receive mechanical ventilation and cardiopulmonary resuscitation than women.
Over time, the use of supportive procedures increased, and the use of intensive procedures decreased in patients with stroke in the last month of life. This study highlights a need for research, guidelines, and training in how to provide palliative care for end-stage patients with stroke.
中风是全球范围内的第二大致死原因和首要致残原因。目前尚不清楚处于生命末期的中风患者接受了何种治疗，以及近年来治疗趋势如何。
本研究旨在探讨 2000-2010 年期间台湾地区中风患者在生命最后一个月接受强化和支持性治疗的变化。
分析来自全民健康保险研究数据库的 55930 名中风患者的理赔数据，以探讨 2000-2010 年期间台湾地区中风患者在生命最后一个月接受强化和支持性治疗的变化。
在整个研究期间，25.4%的中风患者在生命的最后一个月入住重症监护病房。接受机械通气（77.4%-67.9%）、心肺复苏（53.8%-35.8%）和正性肌力药（73.5%-64.3%）的患者比例随时间逐渐下降。接受人工水化和营养支持（65.9%-73.3%）和镇静或镇痛剂（34.7%-38.6%）的患者比例随时间逐渐上升。年龄小于 85 岁的患者更有可能入住重症监护病房。男性比女性更有可能接受机械通气和心肺复苏。
随着时间的推移，中风患者在生命最后一个月接受支持性治疗的比例增加，而接受强化治疗的比例下降。本研究强调需要研究、制定指南和培训如何为终末期中风患者提供姑息治疗。
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