神經外科病人的安寧療護
 
陳怡伶¹　黃博浩²　陳怡安^1,3　陳姍婷^1,3　蔡兆勳¹　黃獻樑¹

 
安寧緩和醫療的發展自西元1967年，英國Cicely Saunders於倫敦創立第一間臨終照護機構開始，至今已五十多載。隨著善終的概念漸漸植入人心，法條跟著改變、安寧機構也日益增加。可惜的是目前大部分接受緩和醫療的病人，仍然以癌症末期病人為主。我們鮮少將安寧緩和醫療介入遭遇突發性腦血管或腦外傷事件的神經外科病人和家屬。但這些族群其實承受巨大的心理創傷，也面臨醫療決策大難題；外科醫師在評估預後時也有許多未知數，這些安寧共照團隊都可以提供幫助。本專論蒐集了近年內國內外的學術文章，討論(1)神經外科重症病人的疾病特性，及安寧需求。(2)神經外科醫師照會安寧團隊的最佳時機點。(3)安寧團隊在神經外科病房的角色、介入的技巧及評估介入的成效。(4)病人自主權利法上路後帶來的影響。(5)神經外科住院醫師訓練中應包含的安寧概念與溝通技巧。
（台灣家醫誌2021; 31: 5-12）DOI: 10.3966/168232812021033101002
 
關鍵詞：安寧醫療、緩和醫療、神經外科、神經重症
 

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¹國立台灣大學醫學院附設醫院家庭醫學部、²神經外科、³護理部
受理日期：109年3月4日　　修改日期：109年5月30日　　同意刊登：109年8月31日
通訊作者：黃獻樑　　　　 通訊地址：台北市中山南路7號　台大醫院家庭醫學部

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Palliative Care for Neurosurgical Patients
 
I-Ling Chen¹, Abel Po-Hao Huang², Yi-An Chen^1,3, Shan-Ting Chen^1,3, Jaw-Shiun Tsai1 and
Hsien-Liang Huang¹
 

Hospice care has emerged and evolved over the past 50 years since Dame Cicely Saunders founded the first terminal care facility in London. The idea of maximizing life quality at the end of life has spread throughout the world, triggering the establishment of an increasing number of hospices and monumental changes in regulations. However, hospice care for neurosurgical patients has remained understudied. The patients themselves have to endure tremendous pain, and their families suffer from enormous physical and mental stress, as well as difficulty in decision making. Physicians too are challenged with predicting prognosis. In this article, we reviewed studies regarding indications, benefits and optimal timing of palliative care among victims of traumatic brain injury or severe stroke patients in neurology intensive care units. We discussed the following issues: (1) Disease characteristics of neurosurgical patients and their palliative care needs; (2) The optimal timing for initiating palliative care in these patients; (3) The intervention of the palliative care team in helping patients; (4) The impacts of the promulgated Patient Right to Autonomy Act on neuro-palliative care; and (5) Palliative care skills that should be emphasized during surgery residency.
(Taiwan J Fam Med 2021; 31: 5-12) DOI: 10.3966/168232812021033101002
 
Key words:hospice care, neurocritical, neurosurgery, palliative care
 

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¹Departments of Family Medicine, ²Neurosurgery and³Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
Received: March 4, 2020; Revised: May 30, 2020; Accepted: August 31, 2020.