Ghusn H F, Teasdale T A, Skelly J R
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
J Am Geriatr Soc. 1995 Oct;43(10):1131-4. doi: 10.1111/j.1532-5415.1995.tb07014.x.
To determine nursing home medical directors' knowledge about cardiopulmonary resuscitation outcome and their support of treatment limitation requests and policies.
Mailed questionnaire, followed by telephone interview.
Forty-six medical directors of 70 community nursing homes in Harris County, Texas.
Medical directors were asked to estimate the CPR survival rate to discharge of all nursing home residents and that of two case scenarios. They were asked to indicate on a Likert scale their support for mandatory Do-Not-Resuscitate orders and for requests by nursing home patients to withhold other life support measures.
Responses were received from 33 directors. Overall CPR survival rate of older nursing home residents after cardiac arrest was thought to be 10.7%. The average CPR survival rate for healthy older people with witnessed arrests was believed to be 13.8%. The perceived rate for unwitnessed arrests in terminal patients was 4.6%, significantly lower than estimates for healthy older people (P = .003) and estimates of the overall survival rate (P = .02). Medical directors were split regarding mandatory Do-Not-Resuscitate orders for patients in vegetative states, with terminal illness, with an unwitnessed arrest, or in those older than 90 years of age. Mandatory use of Do-Not-Resuscitate orders for all nursing home residents was strongly opposed. Assuming a 2% survival rate did not significantly influence medical directors' opinions about mandatory DNR orders in these groups. Medical directors were more willing to support requests by stable nursing home residents to withhold resuscitation, mechanical ventilation, or hospitalization than requests to withhold antibiotics, intravenous fluids, or tube feedings (P < .005). The majority of medical directors were willing to withhold all such measures for terminal patients.
Health care professionals who are responsible for educating patients about the efficacy of cardiopulmonary resuscitation in nursing homes overestimate its benefit and may benefit from further education about its outcome. Although mandatory Do-Not-Resuscitate orders were favored for terminal or vegetative patients, medical directors are not supportive of such orders across the board. Medical directors are more willing to honor requests for treatment limitation by terminal patients than others.
确定疗养院医疗主任对心肺复苏结果的了解程度以及他们对治疗限制请求和政策的支持情况。
邮寄问卷调查，随后进行电话访谈。
得克萨斯州哈里斯县70家社区疗养院的46名医疗主任。
要求医疗主任估计所有疗养院居民心肺复苏至出院的存活率以及两种病例情况的存活率。要求他们用李克特量表表明对强制“不要复苏”医嘱以及疗养院患者提出的拒绝其他生命支持措施请求的支持程度。
收到了33位主任的回复。心脏骤停后老年疗养院居民的总体心肺复苏存活率被认为是10.7%。有目击的心脏骤停的健康老年人的平均心肺复苏存活率被认为是13.8%。终末期患者未被目击的心脏骤停的存活率为4.6%，显著低于对健康老年人的估计（P = 0.003）和总体存活率的估计（P = 0.02）。对于处于植物人状态、患有晚期疾病、心脏骤停未被目击或年龄超过90岁的患者，医疗主任在强制“不要复苏”医嘱问题上存在分歧。强烈反对对所有疗养院居民强制使用“不要复苏”医嘱。假设2%的存活率并未显著影响医疗主任对这些群体强制“不要复苏”医嘱的看法。与拒绝使用抗生素、静脉输液或管饲的请求相比，医疗主任更愿意支持病情稳定的疗养院居民提出的拒绝复苏、机械通气或住院治疗的请求（P < 0.005）。大多数医疗主任愿意对终末期患者拒绝所有此类措施。
负责向疗养院患者宣传心肺复苏疗效的医护人员高估了其益处，可能需要接受关于其结果的进一步教育。尽管对于终末期或植物人患者倾向于实施强制“不要复苏”医嘱，但医疗主任并不完全支持此类医嘱。医疗主任比其他人更愿意尊重终末期患者提出的治疗限制请求。
