临终病情评估单预测临终患者生存期的效果

doi:10.6040/j.issn.1671-7554.0.2022.1162

摘要/Abstract

摘要： 目的评价临终患者病情评估单预测临终患者生存期的效果。方法回顾性分析2020年4月至2022年2月山东电力中心医院老年病区死亡的26例临终患者的临床资料。计算预期生存时间与实际生存时间的符合率、预测生存时间少于30 d的评分界值的合理性。绘制生存曲线并探讨各评估因素对生存时间的影响。采用临终病情评估单对生命体征等指标进行评分,各项指标综合得出综合性得分,分析与生存期的关联。结果入院时评估的符合率65.38%。部分评估项目设有警示指标,多个警示指标预测生存期不足3 d的符合率100%。最常见的警示指标:意识状态的改变(76.92%),收缩压<80 mmHg(38.46%),呼吸>30次/min(26.92%)。50分作为预测生存时间少于30 d界限值的灵敏度为77.78%,特异度为83.33%,阳性预测值93.33%,阴性预测值55.55%,约登指数为0.61。评分在50分及以下组、评分在50分以上组生存时间存在着统计学差异(P=0.021)。Cox分析显示:临终病情评估单评分呼吸(HR=0.609,95%CI:0.381~0.973)、脉搏(HR=0.615,95%CI:0.426~0.889)、脏器状况(HR=0.362,95%CI:0.170~0.773)对生存时间的影响具有统计学意义(P<0.05)。结论临终患者病情评估单能够比较准确地评估晚期癌症、慢性器官衰竭、失智等临终患者的生存期。

关键词: 病情评估单, 临终患者, 生存期预测, 警示指标, 姑息治疗

Abstract: Objective To evaluate the efficacy of Terminal Patient Condition Assessment Form in predicting the survival time of terminal patients. Methods Clinical data of 26 terminal patients admitted to the geriatric ward of Shandong Electric Power Central Hospital during Apr. 2020 and Feb. 2022 were retrospectively analyzed. The match rate between predicted and actual survival time was calculated, and the rationality of score threshold for predicting survival time less than 30 d was determined. The survival curve was drawn and the influence of each predicting factor on survival time was investigated. The vital signs and other indicators were scored with the Terminal Patient Condition Assessment Form, the total scores were obtained, and the correlation between the scores and survival time was analyzed. Results The match rate of assessment at admission was 65.38%. Some predicting items included warning indicators. The match rate of warning indicators in predicting survival time less than 3 d was 100%. The most common warning indicators were the changes of consciousness(76.92%), systolic blood pressure <80 mmHg(38.46%), and respiratory rate>30/min(26.92%). The sensitivity and specificity of 50 points as score threshold for predicting survival time less than 30 d were 77.78% and 83.33%, respectively; the positive and negative predictive value were 93.33% and 55.55%, respectively; the Youden index was 0.61. There was significant difference in survival time between the group with score ≤50 points and group with score >50 points(P=0.021). Cox analysis showed scores of respiratory(HR=0.609, 95%CI:0.381-0.973), pulse(HR=0.615, 95%CI:0.426-0.889)and organ status(HR=0.362, 95%CI:0.170-0.773)had significant effects on survival time(P<0.05). Conclusion Terminal Patient Condition Assessment Form can accurately predict the survival time of terminal patients with advanced cancer, chronic organ failures, dementia and so on.

Key words: Terminal Patient Condition Assessment Form, Terminal patient, Prediction of survival time, Warning indicators, Palliative care

中图分类号:

蔡强,单悌超,吴晗. 临终病情评估单预测临终患者生存期的效果[J]. 山东大学学报 (医学版), 2023, 61(5): 79-83.

CAI Qiang, SHAN Tichao, WU Han. Efficacy of terminal patient condition assessment form in predicting survival time of terminal patients[J]. Journal of Shandong University (Health Sciences), 2023, 61(5): 79-83.

参考文献

[1] Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical recommendations-a study by the Steering Committee of the European Association for Palliative Care[J]. J Clin Oncol, 2005, 23(25): 6240-6248.
[2] 王粲霏, 贾会英, 吴珂, 等. 多学科协作模式在安宁疗护中的应用研究进展[J]. 中华护理杂志, 2018, 53(7): 866-872.
[3] 侯莉, 陈文琪, 邓丹丹. 安宁缓和医疗中的预期寿命评估[J]. 中国临床保健杂志, 2021, 24(1): 10-13. HOU Li, CHEN Wenqi, DENG Dandan. Life expectancy assessment in hospice and palliative care[J]. Chin J Clin Healthc, 2021, 24(1): 10-13.
[4] 上海市社区卫生服务中心临终病人病情(生存期)评估单. 上海市社区舒缓疗护(临终关怀)工作规范[S]. 上海市卫生局, 2012.
[5] 毛伯根, 严勤, 谢懿珍, 等. 临终病人病情评估表的初步编制[J]. 中国医疗前沿, 2009, 4(19): 4-6. MAO Bogen, YAN Qin, XIE Yizhen, et al. The initial establishment of assessed illness table in the patient approaching end[ J]. China Healthcare Frontiers, 2009, 4(19): 4-6.
[6] 吴斌, 武丽桂, 袁玲, 等. 肿瘤晚期患者生存期预测研究进展[J]. 中华护理杂志, 2019, 54(2): 295-300.
[7] 郁文恺, 陈健琳, 雷锐, 等. 临终患者病情评估表与常见生存期预测量表对癌症晚期患者生存期预测准确性比较研究[J]. 中国全科医学, 2022, 25(7): 851-858. YU Wenkai, CHEN Jianlin, LEI Rui, et al. A comparative study on the accuracy of prognosis of the End-of-life Assessment Form and common survival prediction scales in advanced cancer patients[J]. Chinese General Practice, 2022, 25(7): 851-858.
[8] 黄建萍, 毛伯根. 临终患者病情评估表用于晚期恶性肿瘤患者生存时间预测的评价[J]. 护理学杂志, 2014, 29(17): 6-8. HUANG Jianping, MAO Bogen. The dying patient condition assessment sheet: prediction of expected survival time in advanced cancer patients[J]. Journal of Nursing Science, 2014, 29(17): 6-8.
[9] Lunney JR, Lynn J, Foley DJ, et al. Patterns of functional decline at the end of life[J]. JAMA, 2003, 289(18): 2387-2392.
[10] Welsch K, Gottschling S. Wishes and needs at the end of life-communication strategies, counseling, and administrative aspects[J]. Dtsch Arztebl Int, 2021, 118(17): 303-312.
[11] 宋红伟, 胡敏, 黑子明, 等. 上海市20家社区卫生服务中心安宁舒缓疗护服务现况调查[J]. 中国全科医学, 2015,18(16): 1972-1976. SONG Hongwei, HU Min, HEI Ziming, et al. Investigation of service status of quiet soothing care in 20 pilot community health service centers in Shanghai[J]. Chinese General Practice, 2015, 18(16): 1972-1976.
[12] 郁文恺, 雷锐, 陈健琳, 等. 临终患者病情评估表在晚期胃癌患者生存期预测中的应用与效果评价[J]. 上海医药, 2021, 42(18): 33-36. YU Wenkai, LEI Rei, CHEN Jianlin, et al. Application and effect evaluation of dying patient condition assessment form in predicting survival time of patients with advanced gastric cancer[J]. Shanghai Medical & Pharmaceutical Journal, 2021, 42(18): 33-36.
[13] 杨晓琳, 刘芳, 王越晖. 老年安宁缓和医疗的多维度评估[J]. 中国老年学杂志, 2022, 42(3): 764-767.
[14] Teunissen SC, Wesker W, Kruitwagen C, et al. Symptom prevalence in patients with incurable cancer: a systematic review[J]. J Pain Symptom Manage, 2007, 34(1): 94-104.
[15] 赵舞阳, 王玉梅, 崔檬, 等. 基于姑息预后指数(PPI)的晚期胃癌患者的生存分析[J]. 中国卫生统计, 2017, 34(6): 900-903. ZHAO Wuyang, WANG Yumei, CUI Meng, et al. Survival analysis of patients with advanced gastric cancer based on PPI[J]. Chinese Journal of Health Statistics, 2017, 34(6): 900-903.

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