Bedell S E, Pelle D, Maher P L, Cleary P D
JAMA. 1986 Jul 11;256(2):233-7.
We studied compliance with do-not-resuscitate (DNR) orders at a university hospital where a DNR protocol has existed since 1979. Documentation of DNR status in patient progress notes and chart orders increased through 1983. During a 12-month period (March 1983 through April 1984), we studied in detail the medical records of 521 patients who had a cardiopulmonary arrest in the hospital. Seventy-five percent (389 of 521) of these patients were designated DNR. Patients who were designated DNR were significantly more likely to be older, to have malignancy or an abnormal mental status, and to be less likely to have acute myocardial infarction, stroke, or chronic obstructive pulmonary disease than patients in whom resuscitation was attempted. Eighty-six percent of families, but only 22% of patients, were involved in the decision to designate a patient DNR. The decision to designate a patient DNR occurred late in the course of a patient's illness, often when the patient was in coma. For 28% of patients, some form of medical care was withdrawn or withheld after they were designated DNR. These data suggest that use of the DNR protocol requires changes if patients are to participate in the decision not to undergo cardiopulmonary resuscitation.
我们在一所自1979年起就有“不要复苏”（DNR）方案的大学医院研究了对DNR医嘱的依从性。至1983年，患者病程记录和医嘱单中DNR状态的记录有所增加。在12个月期间（1983年3月至1984年4月），我们详细研究了521例在医院发生心肺骤停患者的病历。这些患者中有75%（521例中的389例）被指定为DNR。与尝试进行复苏的患者相比，被指定为DNR的患者年龄更大、更有可能患有恶性肿瘤或精神状态异常，而患急性心肌梗死、中风或慢性阻塞性肺疾病的可能性更小。86%的家属参与了将患者指定为DNR的决定，但只有22%的患者参与了该决定。将患者指定为DNR的决定通常在患者病程后期做出，常在患者昏迷时。在28%的患者被指定为DNR后，某种形式的医疗护理被撤销或停止。这些数据表明，如果患者要参与不接受心肺复苏的决定，DNR方案需要做出改变。
