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[重症监护中成人临终期的治疗与支持:德国重症监护与急诊医学学会伦理委员会及德国姑息医学学会的建议。第1部分:重症监护中临终关怀与死亡的关键方面。第2部分:重症监护中临终期的治疗措施与支持]

[Treatment and Support for Adults at the End of Life in Intensive Care : A Recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. Part 1: Key Aspects of End-of-Life Care and Dying in Intensive Care. Part 2: Therapeutic Measures and Support at the End of Life in Intensive Care].

作者信息

Münch Urs, Duttge Gunnar, Eggardt T Johannah, Gretenkort Peter, Kleinschmidt Stefan, Meier Stefan, Nauck Friedemann, Neitzke Gerald, Neukirchen Martin, Salomon Fred, Schallenburger Manuela, Seidlein Anna-Henrikje, Vonderhagen Sonja, Weber Claudia, Jöbges Susanne

机构信息

DRK Kliniken Berlin, Berlin, Deutschland.

Zentrum für Medizinrecht und Institut für Kriminalwissenschaften, Georg-August-Universität Göttingen, Göttingen, Deutschland.

出版信息

Med Klin Intensivmed Notfmed. 2025 Aug 29. doi: 10.1007/s00063-025-01327-z.

Abstract

The primary goal of intensive care medicine is to overcome a critical phase of illness using all available means and to enable patients to survive and return to an independent life without intensive care. However, this therapeutic goal cannot always be achieved. The possibility of death, the need to alleviate suffering, and respect for the end of life make it necessary to integrate palliative approaches into intensive care medicine. Supporting seriously ill and dying patients and their relatives in intensive care units requires an attitude that holistically recognizes and respects their individuality and is shared by the entire team. In addition to recognizing life and death, reliable structures, clear agreements, and palliative care skills among the respective professional groups are necessary. When implementing these approaches, it is important to remain within the framework of legal requirements and to take the wishes of those affected into account. In addition to the relevant professional expertise, the most important tool is respectful and clear communication with all those involved and affected. Help should be available at all times in cases of uncertainty regarding ethical and palliative issues, as well as in cases of psychological stress.

摘要

重症医学的主要目标是利用一切可用手段克服疾病的关键阶段,使患者能够存活并在无需重症监护的情况下恢复独立生活。然而,这一治疗目标并非总能实现。死亡的可能性、减轻痛苦的必要性以及对生命终结的尊重使得有必要将姑息治疗方法融入重症医学。在重症监护病房支持重症患者和临终患者及其亲属需要一种态度,即全面认识并尊重他们的个性,且整个团队都应秉持这种态度。除了认识到生死之外,各专业群体之间还需要可靠的架构、明确的协议以及姑息治疗技能。在实施这些方法时,重要的是要保持在法律要求的框架内,并考虑到受影响者的意愿。除了相关专业知识外,最重要的工具是与所有相关和受影响的人进行尊重且清晰的沟通。在涉及伦理和姑息治疗问题存在不确定性的情况下,以及在出现心理压力的情况下,应随时提供帮助。

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