在严重中风中预后和决策
Robert G Holloway1, Curtis G Benesch, W Scott Burgin
1Department of Neurology, University of Rochester School of Medicine, Rochester, NY 14642, USA. robert_holloway@urmc.rochester.edu
JAMA
|August 11, 2005
概括
机械通风中风患者的预后通常很差,死亡率很高. 然而,一些幸存者有良好的结果,需要谨慎,以患者为中心的决策,关于维持生命的治疗.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 医学伦理 医学伦理
背景情况:
- 严重的中风往往导致机械通风和高死亡率.
- 退休护理实践的变化可能会导致不必要的痛苦或过早死亡.
研究的目的:
- 审查机械通风中风患者预后的证据.
- 为患者和家人建立一个优化临床决策的框架.
主要方法:
- 在MEDLINE (1980-2005) 的系统文献搜索中找到相关的英语文章.
- 在689个已识别的物品中选择了17个物品.
- 对影响维持生命治疗决策的因素和潜在偏见的分析.
主要成果:
- 总体死亡率高 (大约. 在机械通风中风患者中,在30天后的58%).
- 幸存者可能会经历无/轻度残疾 (高达三分之一) 或严重残疾.
- 预后可以通过使用中风类型,患者特征和临床预测规则来改进.
结论:
- 预后通常不好,但有一部分患者在没有严重残疾的情况下存活下来.
- 临床表现和患者特征有助于预后评估.
- 更好地了解护理变化和以患者为中心的决策至关重要.
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