全肠坏死性小肠结肠炎患儿处理中的伦理困境
Ethical dilemmas in the management of infants with necrotizing enterocolitis totalis.
机构信息
Helen DeVos Children's Hospital and Michigan State University College of Human Medicine, 330 Barclay Ave NE, Suite 202, Grand Rapids, MI 49503.
Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA.
出版信息
J Pediatr Surg. 2022 Mar;57(3):329-334. doi: 10.1016/j.jpedsurg.2021.08.026. Epub 2021 Sep 21.
PURPOSE
Necrotizing enterocolitis (NEC) totalis is a devastating disease of the newborn intestine. A precise clinical definition of the extent of gastrointestinal involvement is lacking in the existing literature, and the clinical outcomes are typically viewed as grim.
METHODS
Herein, we present a series of clinical case examples of patients with varying degrees of NEC totalis and other co-morbid conditions, with possible anticipated outcomes based on current data.
RESULTS
We define the key ethical issues and provide a framework and discussion of the ethical issues involved in the care of patients with NEC totalis and recommendations of how to approach discussions with the family of these patients We discuss the ethical considerations for both the providers caring for these patients, and the patient's family members.
CONCLUSION
The management of patients with NEC totalis is complex and ethically challenging.
LEVEL OF EVIDENCE
V.
目的
坏死性小肠结肠炎（NEC）是一种严重的新生儿肠道疾病。现有文献中缺乏对胃肠道受累程度的精确临床定义，且临床结局通常被认为较为严峻。
方法
在此，我们呈现了一系列患有不同程度 NEC 总合征和其他合并症的患者的临床病例示例，并根据现有数据预测可能的预后。
结果
我们定义了关键的伦理问题，并提供了一个框架，讨论了在照顾 NEC 总合征患者时所涉及的伦理问题，并提出了与这些患者的家属进行讨论的建议。我们讨论了照顾这些患者的医护人员和患者家属的伦理考量。
结论
NEC 总合征患者的管理复杂且具有伦理挑战性。
证据等级
V。
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