综合医院28例腹盆腔癌症终末期患者的安宁疗护实践

目的 总结28例腹盆腔癌症患者终末期的安宁疗护护理,便于指导安宁疗护临床实践。 方法 选取2017年5月至2018年12月西南医科大学附属医院肿瘤科收治的28例腹盆腔癌症终末期患者,对患者及其家属实施以护士为主导的医护一体、多学科合作的安宁疗护共照团队护理,分别对患者实施症状管理、舒适护理、心理照护、死亡教育,对患者亲属实施哀伤辅导等。结果 总结安宁照护行为对其结局指标的影响,28例患者均制定预立医疗照护计划。通过症状管理,25例(89.28%)患者腹胀症状明显缓解,28例患者疼痛得到有效控制,NRS评分维持在0~3分,水肿症状得到有效缓解,5例双下肢水肿患者出现张力性水泡,护理后无一例出现皮肤破溃和感染。25例(89.28%)患者在家属陪伴及医护见证下对生命末期治疗及护理、死亡地点的选择、抢救与否、遗体处置等事宜作出安排。临终治疗抉择:仅3例(10.71%)选择心肺复苏;1例(3.57%)选择气管插管;0例选择电击除颤和入住ICU病房;其中1例在安宁疗护共照团队协助下完成眼角膜捐献。结论 通过构建以护士为主导的医护一体、多学科合作的安宁疗护共照团队模式,可以提高腹盆腔癌症终末期患者舒适感,缓解症状,帮助患者及家属正确面对死亡。

Practice of hospice care in 28 patients with terminal cancer of abdomen and pelvis in general hospital

Objective To summarize the end-stage tranquility nursing care of 28 patients with abdominal and pelvic cancer, and guide the clinical practice of tranquility nursing.Methods From May 2017 to December 2018, 28 patients with end-stage pelvic cancer admitted to the Department of Oncology, Affiliated Hospital of Southwest Medical University were selected, and patients and their families were treated with nurse-led medical treatment and multidisciplinary cooperation. Nursing care team care, implement symptom management, comfort care, psychological care, death education, sorrow counseling, etc were conducted.Results Summarizing the impact of tranquil care behavior on its outcome indicators, 28 patients all developed pre-established medical care plans. Through symptom management, 25 patients(89.28%)had significantly relieved bloating symptoms, 28 patients had effective pain control, NRS score was maintained at 0 to 3 points, edema symptoms were effectively relieved, and 5 patients with lower limb edema developed tension blisters. No cases of skin rupture and infection occurred after treatment. Twenty-five patients(89.28%)made arrangements for end-of-life treatment and care, choice of place of death, whether to be rescued, and disposal of corpses under the witness of family members and medical care. End-of-life treatment choices: only 3 patients(10.71%)selected cardiopulmonary resuscitation; 1 patient(3.57%)selected endotracheal intubation; no patients selected electroshock defibrillation and admission to the ICU ward; 1 of them was completed with the assistance of the annu treatment nursing team corneal donation.Conclusion By constructing a nurse-led medical and nursing integration, multi-disciplinary cooperation and peaceful care team model, it can improve the comfort of patients with end-stage pelvic cancer, relieve symptoms, and help patients and their families fight against death correctly.