在重病退伍军人中选择维持生命治疗的模式
Connie S Cole1,2, Paula R Langner1, Susan C Miller3
1VA Eastern Colorado Health Care System, Aurora, Colorado, USA.
Journal of the American Geriatrics Society
|August 28, 2025
概括
随着时间的推移,患者对心肺复苏的偏好可能会发生变化,特别是在重病退伍军人中. 了解这些转变对于将医疗保健与个人价值观相协调以及提前改善护理规划至关重要.
科学领域:
- 老年学
- 医疗服务研究
- 临床信息学
背景情况:
- 预先计划护理和记录维持生命治疗 (LST) 的偏好对于以患者为中心的护理至关重要.
- 患者对LST的偏好稳定性,特别是在社区居住的老年人中,需要进一步调查.
- 退伍军人事务部 (VA) 生命维持治疗决策倡议为研究重病退伍军人的偏好轨迹提供了有价值的数据集.
研究的目的:
- 在退伍军人中确定不同的心肺复苏 (CPR) 偏好轨迹.
- 在每个已识别的CPR偏好轨迹中描述退伍军人.
- 检查人口和临床因素与CPR偏好轨迹成员之间的关联.
主要方法:
- 对VA企业数据仓库数据进行了纵向观察分析.
- 截至2019年10月1日,已完成LST模板的161,725名退伍军人被纳入.
- 使用序列分析分析了39个月的心肺复苏偏好 (全代码与不复苏 (DNR)) 稳定性,并通过多项逻辑回归确定了相关因素.
主要成果:
- 确定了四种CPR偏好轨迹:持续的DNR (39.8%),随着早期死亡率的波动 (8.7%),随着晚期死亡率的波动 (7.3%) 和持续的全代码 (44.3%).
- 年长的退伍军人更有可能保持DNR偏好,而年轻的退伍军人更喜欢全代码.
- 更高的并发症负担,心力衰竭和增加的住院率与偏好波动有关;痴呆症与持续的DNR有关.
结论:
- 退伍军人的心肺复苏偏好轨迹复杂而动态, 需要个性化的预先护理计划.
- 医疗保健提供者应考虑动态的临床因素,并将住院治疗作为治疗讨论的机会.
- 文化敏感的沟通对于使治疗偏好与患者不断变化的目标和价值观保持一致至关重要.
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