研究背景：有越來越多重症病人在加護病房進入生命末期，即使有簽署不施行心肺復甦術同意書(Do Not Resuscitate,DNR)，在臨床積極治療無效後，想轉安寧緩和病房時間通常已嫌太晚，造成病人及家屬的遺憾。研究目的:探討呼吸加護病房簽署不施行心肺復甦術同意書與急救醫療處置施行之相關因素分析。研究設計:本研究為回溯性研究，對象在台灣中部地區某醫學中心呼吸加護病房，自2008年1月至2011年12月底入住呼吸加護病房，年滿二十歲有肺癌或慢性阻塞性肺疾病病人，APACHEII分數≧20分之重症病人。以自擬之研究工具「加護病房病人簽署不施行心肺復甦術同意書對急救醫療處置之相關調查表」進行資料收集。研究結果:共計304人，有簽署DNR病人148人，未簽署DNR者156人。所得資料以卡方檢定、t檢定、相關性分析及羅吉斯迴歸檢定分析。研究結果發現:呼吸加護病房病人簽署DNR之急救醫療處置結果，肺癌病人及慢性阻塞性肺疾病病人對於急救醫療處置項目中，使用血管升壓劑及接受插管處置最多，高於其他項目，其中有簽署DNR病人使用血管升壓劑為79.1%，另外，接受插管處置為85.1%。呼吸加護病房重症病人接受緊急醫療處置之預測因子:結果顯示病人APACHE II越高、入住加護病房時間越長、有簽署DNR能預測有無使用血管升壓劑；病人APACHE II越高、年齡較輕能預測有無使用急救藥物；入住加護病房天數越短及年齡較輕能預測有無接受心外按摩處置；病人入住加護病房天數越長、沒簽署DNR、已婚、由病房轉入能預測有無接受插管處置。結論:此研究顯示304個病人中，有簽署DNR者148人(48.7%)，其中簽署DNR死亡為115人(77.7%)，病人在使用血管升壓劑比率高，預後不好，可以提供今後加護病房醫護人員面對病人及家屬同意簽署DNR時之臨床實證參考，期望能提升臨床照護病人的品質。

Background:There are more and more patient in the ICU into the end of life,the patients even if no sign Resuscitate Consent (Do Not Resuscitate,DNR).The patientinthe terminal stage still active inthe clinical treatment.Some patients would like to turn palliative to care,but usually had too late.Itcaused the the families of regret.
Objective:Toinvestigate therelated factors of DNR consent in respiratoryICUand the implementation ofthe emergencymedical treatment.
Study Design:This study wasa retrospective study. The data collected by the respiratory intensive care in a medical center of central Taiwan in since January 2008 by the end of December 2011 to stay respiratory intensive care unit. Theinclusion criteria waslung cancer or chronic obstructive Pulmonary Disease ,APACHE II scores≧20 points. The questionnaire was “ICU patient not Resuscitate signed consent form for medical treatment “for data collection. Data were analyzed by descriptive and infernal statistics(Chi-square test or Fisher`s exact test, T test, and logistic regression).
Results: A total of 304 patients comprising 148(48.7%) who had the DNR consent. The results showed that a total of 304 patients were included, whereas 148 patients had signed the DNR consent. The most data of emergency treatment in respiratory ICU were: sign on DNR patients with vasopressor agents (79.1%) and with Endo (85.1%). The results of multiple logistic regression showed that the predictors of using vasopressor agents were: APACHE II (Wald=15.243, p=.000), the duration of living in respiratory ICU (Wald=9.222,p=.002) and signed DNR consent (Wald=19.069, p=.000). The predictors of emergency agents were: APACHE II (Wald=4.950, p=.026) and younger age (Wald=4.940, p=.002). The predictors of cardiac massage treatment were: the duration of living in respiratory ICU (Wald=4.239, p=.039) and younger age (Wald=5.405, p=.020). The predictors of Endo intubation were: the duration of living in respiratory ICU (Wald=8.208, p=.004), without DNR consent (Wald=4.035,p=.045), marriage(Wald=7.828, p=.005) and transfer from ward(Wald=7.828, p=.005). These results are valuable in providing high quality care of respiratory ICU patients.
Conclusion:The results of study showed that 148(48.7%) of the 304 patients provided informed consent of do-not-resucitate (DNR).The mortality rate of DNR group was 115(77.7%).Patients were more and more use of vasopressor agants,had poor prognosis.It is suggested that encouraging the medical personnel to discuss the DNR consent earlier with patients and their families,the better decision could be made.

目錄
致謝..........................................................................................................I
論文摘要.................................................................................................II
Abstract..................................................................................................III
目錄........................................................................................................V
表目錄...................................................................................................VII
圖目錄..................................................................................................VIII
第一章緒論.............................................................................................1
第一節研究動機..................................................................................1
第二節研究重要性..............................................................................2
第三節研究目的..................................................................................3
第四節研究問題....................................................................................3
第五節名詞解釋及操作性定義............................................................3
第二章文獻查證.....................................................................................5
第一節肺部重症疾病與其特性............................................................5
第二節加護病房病人之醫療處置.........................................................8
第三節加護病房病人之重症末期醫療照護........................................10
第四節不施行心肺復甦術的起源及定義............................................10
第五節加護病房病人簽署DNR之相關研究......................................11
第三章研究方法...................................................................................14
第一節研究架構................................................................................14
第二節研究假說................................................................................14
第三節研究設計................................................................................15
第四節研究場所及研究對象..............................................................15
第五節研究工具................................................................................15
第六節研究倫理考量.........................................................................16
第七節資料處理與分析.....................................................................17
第四章結果與分析................................................................................18
第一節呼吸加護病房病人簽署DNR之急救醫療處置結果................18
第二節呼吸加護病房重症病人接受緊急醫療處置之預測因子.............40
第五章討論.............................................................................................44
第一節呼吸加護病房病人簽署DNR之急救醫療處置結果................44
第二節呼吸加護病房重症病人接受緊急醫療處置之預測因子.............45
第六章結論與建議..................................................................................47
第一節結論.......................................................................................47
第二節研究限制................................................................................47
第三節建議.......................................................................................48
附件.......................................................................................................50
參考文獻................................................................................................52

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