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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >The use of advance directives among patients with implantable cardioverter defibrillators
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The use of advance directives among patients with implantable cardioverter defibrillators

机译：在植入式心脏复律除颤器中使用预先医疗指示

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Background: We aimed to determine the prevalence of advance directives (ADs) among patients with implantable cardioverter defibrillators (ICDs) and of ADs that addressed ICD management at the end of life. Methods: The medical records of all patients who underwent ICD implantation during 2007 at a single institution were reviewed retrospectively to determine the number of patients with an AD and the number of ADs mentioning the ICD specifically (i.e. ICD management at end of life). Results: During 2007, 420 patients (males, 71%) underwent ICD implantation at our institution (mean age [range] at implantation, 63 [1-90] years). Primary prevention was the most common indication for device therapy (254 patients [61%]). Overall, 127 patients (30%) had an AD, with 83 ADs (65%) completed more than 12 months before ICD implantation and 10 (8%) completed after it. Several life-sustaining treatments were mentioned in the ADs: tube feeding, 46 (37%); cardiopulmonary resuscitation, 25 (20%); mechanical ventilation, 22 (17%); and hemodialysis, nine (7%). Pain control was mentioned in 58 ADs (46%) and comfort measures in 38 (30%). However, only two ADs (2%) mentioned the ICD or its deactivation at end of life. Conclusions: About one-third of patients with ICDs had an AD, but only a couple ADs mentioned the ICD. These results suggest that clinicians should not only encourage patients with ICDs to complete an AD, but also encourage them to address ICD management specifically. Not addressing ICD management in an AD may result in ethical dilemmas during end-of-life care. (PACE 2012; xx; 1-7)
机译：背景：我们的目的是确定在植入式心脏复律除颤器（ICD）患者中以及在生命终结期解决ICD管理的患者中预先使用指示（AD）的患病率。方法：回顾性回顾2007年在单个机构接受ICD植入的所有患者的病历，以确定患有AD的患者人数和明确提及ICD的AD人数（即生命结束时的ICD管理）。结果：在2007年，我们机构中有420例患者（男性，占71％）接受了ICD植入（植入时的平均年龄[范围]为63 [1-90]岁）。一级预防是设备治疗的最常见指征（254例[61％]）。总体而言，有127例患者（30％）患有AD，其中83例AD（65％）在ICD植入前12个月以上完成，有10例（8％）在ICD植入前完成。在AD中提到了几种维持生命的治疗方法：管饲法46例（37％）;心肺复苏25（20％）;机械通风22（17％）;血液透析的比例为9（7％）。 58位AD（46％）中提到了疼痛控制，而38位（30％）中提到了舒适措施。但是，只有两个AD（2％）提到了ICD或寿命终止时停用它。结论：约三分之一的ICD患者患有AD，但只有少数AD提及ICD。这些结果表明，临床医生不仅应鼓励患有ICD的患者完成AD，还应鼓励他们专门解决ICD的管理问题。如果在AD中未解决ICD管理问题，可能会在临终关怀期间导致道德困境。 （PACE 2012; xx; 1-7）

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