使用电除颤器治疗晚期患者的利弊

一项研究发现：医生很少与病危患者探讨植入式电除颤器的问题，所以许多患者在即将死亡的最后数日、数小时或者数分钟内仍然反复接受电除颤器的电休克。

在生命最后阶段，电除颤电休克导致患者不适、焦躁以及死亡时间延长。在该项研究中研究人员发现：在100例终末期患者中只有27例讨论关闭电除颤器。在这27例患者中，有21例患者或者家属决定关闭电除颤器。即使这些要求撤除电除颤器的患者中，仍然少于45％的患者讨论继续使用除颤器。

另外一项相关报道是：在100例患者中有超过四分之一的患者在生命的最后数月内接受电除颤器电休克，百分之三十在生命最后数分钟内接受电休克。这项研究结果报道于2004年11月7日《内科学年报》。

西奈山医学院成人发育与老年病科助理教授、首席研究员Nathan Goldstein医生说：“在心衰或者生命只剩下数月或者数年患者中，电除颤挽救了数以千计的生命。但是这项研究使医生明白，当患者已经只剩下数日或者数周生命的时候，应当讨论持续使用电除颤器的正面与反面后果。”

Palliative Care for Defibrillator Patients
 
A study has found that doctors rarely discuss implanted defibrillators with their sickest patients, so many of them undergo repeated defibrillator shocks during their last days, hours, or minutes of life as they are dying.

At that late stage of life, defibrillation shocks cause discomfort, anxiety, and a prolonged death. In the study, researchers found that discussions about deactivating defibrillators took place in only 27 of 100 cases of terminally ill patients. Among these 27 patients, 21 patients or family members decided to deactivate the defibrillator. Even among patients with do-not-recuscitate (DNR) orders, discussions about continued use of the defibrillator occurred in fewer than 45% of cases.

Next of kin reported that more than one-quarter of the 100 patients received a shock from the defibrillator in the last month of life, and 30% of that group received a shock in the last minutes of life. The study findings were reported in the December 7, 2004, issue of the Annals of Internal Medicine.

“Among patients with heart failure and months or years to live, defibrillators save thousands of lives,” said lead investigator Nathan Goldstein, M.D., assistant professor, department of geriatrics and adult development, Mount Sinai School of Medicine (New York, NY, USA). “However, this study makes clear that physicians should talk about the pros and cons of continuing the device when patients are approaching the last days or weeks of life.”