摘要
目的分析影响恶性肿瘤患者临终抢救方式的因素。方法回顾性分析了2011年1月至2017年12月三六三医院肿瘤科493例死亡的恶性肿瘤患者的资料。按临终抢救情况分为3组,A组:家属放弃所有临终抢救;B组:采取无创性抢救措施;C组:有创抢救。分析性别、年龄、确诊到临终抢救的病程、恶病质、婚姻、职业、肿瘤类别、抢救史、死亡前3个月是否行放化疗、肿瘤分期、合并疾病等因素与临终抢救类型的关系。计数资料采用Pearson卡方检验,单因素分析有意义指标纳入多因素分析,多因素分析采用Logistic回归分析。结果患者女170例,男323例,中位年龄67岁,放弃临终抢救措306例(62.1%),积极进行临终抢救的187例(占37.9%)。单因素分析中影响是否给予临终抢救(A组vs.B组+C组,)有意义的指标包括:体质量变化(P=0.039),既往有抢救病史(P=0.000),恶病质(P=0.020),3个月内进行过放化疗(P=0.008)。按照A组vs.B组vs.C组的三分类单因素分析有意义的指标包括:既往有抢救病史(P=0.000),恶病质(P=0.001),民族(P=0.001),死亡前是否给予放化疗(P=0.022)。恶病质、既往有抢救病史、死亡前3个月内进行过化疗是影响放弃临终抢救(A组)、给予无创抢救(B组)独立预测因素(P<0.05)。民族、恶病质、既往有抢救病史是影响给予有创抢救(C组)的独立预测因素(P<0.05)。结论恶性肿瘤患者临终抢救方式受到多因素的影响。患者无恶病质、死亡前3个月内未进行过化疗、住院期间有过抢救史的更愿意积极给予临终抢救。
Objective To analyze the factors affecting the ways of end-of-life rescue in the patients with malignant tumor. Methods A retrospective analysis was performed on the data in 493 death patients with malignant tumors in the oncology department of 363 hospital from January 2011 to July 2017.The patients were divided into the three groups according to the end-of-life rescue situation;the group A: the family members gave up all end-of-life rescue;the group B: taking non-invasive rescue measures;the group C:taking invasive end-of-life rescue.The relationship between gender,age,course from diagnosis to end-of-life rescue,cachexia,marriage,occupation,tumor type,rescue history,whether conducting radiotherapy or chemotherapy in 3 month before death,tumor stage and complicating diseases with end-of-life rescue type was analyzed.The Pearson chi-square test adopted the counting data,the significant indexes in single-factor analysis were included in the multivariate analysis,and the Logistic regression was used in the multifactor analysis. Results There were 170 females and 323 males,the median age was 67 years old.Gaving up the end-of-life rescue measures was in 306 cases (62.1%),and 187 cases (37.9%) actively took the end-of-life rescue measures.In the univariate analysis,the meaningful indicators influencing whether giving the end-of-life rescue (group A vs. group B+ group C) included:the change of body mass ( P =0.039),previous rescue history ( P =0.000),cachexia ( P =0.020) and radiatherapy or chemotherapy within 3 months ( P =0.008).According to the three-way classification univariate analysis of group A vs. B vs. C,the meaningful indicators included: previous rescue history ( P =0.000),cachexia ( P =0.001),ethnicity ( P =0.001),whether giving radiotherapy or chemotherapy before death ( P =0.022).Whether having cachexia ,previous rescue history and whether giving chemotherapy in 3 months before death were the independent predictive factors affecting to give up all the end-of-life rescue(group A) and give the non-invasive rescue measures(Group B)( P <0.05).Ethnicity,cachexia and previous rescue history were the independent predictive factors affecting giving the invasive end-of-life rescue (group C)( P <0.05). Conclusion The end-of-life rescue way in the patients with malignant tumor is affected by many factors.The patients without cachexia,whether conducting chemotherapy within 3 month before death,and having the rescue history during hospitalization are more willing to take the end-of-life rescue activily.
作者
杜泽东
马晓羽
金冬梅
陈凤
毛郑霞
张璇
张君芳
蒙荣钦
DU Zedong;MA Xiaoyu;JIN Dongmei;CHEN Feng;MAO Zhengxia;ZHANG Xuan;ZHANG Junfang;MENG Rongqin(Department of Oncology,363 Hospital,Chengdu,Sichuan 610041,China;Clinical Medicine College,Southwest Medical University,Luzhou,Sichuan 646000,China;Department of Science and Education,363 Hospital,Chengdu,Sichuan 610041,China)
出处
《重庆医学》
CAS
2019年第20期3445-3449,共5页
Chongqing medicine
基金
四川省卫生和计划生育委员会普及应用项目(18PJ195)
四川省成都市卫生和计划生育委员会科研课题(2018079)
关键词
恶性肿瘤
临终抢救
临床决策
malignant tumors
end-of-life rescue
decision-making
