探討癌症病童臨終階段的醫療照護--2002~2003病歷回顧

Abstract

本研究目的為探討「癌症病童臨終階段的醫療照護」，收集40位於台北市某醫學中心已死亡癌症病童之病歷，用SPSS 12.0 for Windows套裝軟體進行統計分析，重要結果如下： 1. 最後一次住院接受持續性積極治療到死亡的病童共25位（62.5%）；接受緩和醫療照護的病童只有7位（17.5%），而其中有3位（7.5%）是在最後一次住院時才轉介至緩和醫療照護單位。 2. 曾被診斷為「肺炎」佔65.0%、「敗血症」佔57.5%，其最後一次的平均住院日為54.53（±48.23）天，62.5%住院日超過一個月以上。 3. 曾經有過的症狀與徵象之盛行率百分比：呼吸困難（100.0%）、發燒（95.0%）、出血（90.0%）、心博過速（87.5%）、食慾差（85.0%）、疼痛及疲倦（82.5%）、虛弱及腹脹（80.0%）、躁動及水腫（75.0%）。 4. 在死亡前61-90、29-60、22-28、15-21、8-14、1-7天之症狀與徵象總數之（mean±SD），分別為：16.38±5.54、16.68±6.76、12.00±3.74、13.14±4.35、13.84±4.14、14.25±4.14。 5. 整體而言，本研究之死亡癌症兒童其最後一次『住院天數』與『曾有過之症狀與徵象總數』呈現正相關，相關係數為0.84。 大部分的癌症病童在其臨終階段仍接受積極性的治療，並遭受症狀與徵象的困擾，因此，必須提供更多的關注於臨終癌症病童的緩和照護。

The purpose of the study was to explore the health care for cancer children at terminal stage. Records of 40 children with cancer who died at a medical center in Taipei. Data were analysed by SPSS 12.0 for Windows software. The results can be summarized as followings: 1. Twenty-five（62.5%）of the forty children had aggressive treatment from the last hospitalization to the death. Seven（17.5%）of them had palliative care only. 2. The 65.0% of all children had been diagnosed as pneumonia while 57.5% of them had been diagnosed as sepsis. In our study, the mean （±SD）days of the last hospitalization was 54.53±48.23. 62.5% of all children had hospitalized over one month. 3. Records showed dyspnea(100.0%), fever(95.0%), bleeding (90.0%), tachycardia(87.5%), poor appetite(85.0%), pain/fatigue(82.5%), weakness/abdominal distension(80.0%), irritability/edema(75.0%) among these children. 4. The mean（±SD）number of signs and symptoms per patient in the last 61-90、29-60、22-28、15-21、8-14、1-7 day of life were 16.38±5.54、16.68±6.76、12.00±3.74、13.14±4.35、13.84±4.14、14.25±4.14 . 5. In this study, the days of last hospitalization and the total number of signs and symptoms per patient are positive correlation. The correlation coefficient is 0.84 . Children who die of cancer receive aggressive treatment at the terminal stage. The signs and symptoms were suffering at the terminal stage in children with cancer. Greater attention must be paid to palliative care for children who are dying of cancer.