在息患者中停用心脏植入式电子设备:何时以及如何
Tatiana Oliveira1, Nuno Ferreira Monteiro1, Patrícia Cipriano1
1Internal Medicine Unit, Department of Medicine, Cascais Hospital Dr. José de Almeida, Cascais, Portugal.
Medicina clinica
|July 13, 2024
概括
在生命末期讨论心脏器件停用至关重要. 虽然可植入式心脏转移器除器和左心室辅助设备可能会被停用,但起器和心脏再同步治疗通常不建议停用.
科学领域:
- 心脏病学 心脏病学
- 抚慰性护理是一种缓解性护理.
- 医学伦理 医学伦理
背景情况:
- 心脏植入式电子设备 (CIED) 显著提高了生活质量和生存率.
- 关于CIED停用的讨论对于息治疗和终身护理至关重要.
- 患者的偏好和设备类型会影响停用决定.
研究的目的:
- 审查在息护理机构中关闭各种CIED的考虑因素.
- 澄清在生命结束时关闭可植入心脏转换器除器 (ICD),节律起器,心脏再同步治疗 (CRT) 设备和左心室辅助设备 (LVAD) 的建议.
- 强调预先护理计划对CIED管理的重要性.
主要方法:
- 文献综述和当前关于CIED停用在终身护理中的建议的综合.
- 对不同类型的设备进行临床场景分析和伦理考虑.
- 讨论关闭对患者症状和生活质量的影响.
主要成果:
- 建议在冲击频繁并导致痛苦时关闭植入式心脏转动器除器 (ICD).
- 心脏起器的停用是有争议的,并且通常不会在依赖节奏的患者中进行,因为可能会出现胸肌梗塞症状.
- 不建议停用心脏再同步治疗 (CRT),因为它可能会加剧症状;接受左心室辅助装置 (LVAD) 停用以减轻设备负担.
结论:
- 针对CIED的停用决定必须根据设备类型,患者状况和护理目标进行个性化.
- 提前护理规划至关重要,以确保患者的自主权和关于CIED停用的知情同意.
- 虽然一些CIED在生命终端停用时提供了明显的好处,但其他需要仔细考虑以避免不良结果.
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