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美国之外的舒缓医疗和临终关怀

Author
Suresh Kumar, MBBS, DA, Dip Palmed, MA
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD
Translators
宁晓红, 副主任医师，副教授

引言

舒缓医疗是一项跨学科的医学专业，致力于预防并缓解面临严重疾病的患者及其家人的痛苦，并尽可能保证其生存质量。舒缓医疗的基本原则包括症状管理，设定符合患者价值观及偏好的治疗目标，使患者与所有参与其治疗的人员之间始终保持沟通，为患者及其家庭照料者提供心理社会性、精神性和实际的支持，使不同机构之间保持合作。

在美国及国际上其他地区，如加拿大、英格兰、爱尔兰、澳大利亚和新西兰，临终关怀和舒缓医疗是一门得到认可的医学亚专科。很多欧洲国家的舒缓医疗认证也处于发展过程中。遗憾的是，在世界上其他地区，获得优质舒缓医疗的机会非常有限。一项研究显示，在全球符合条件的患者中，只有8%的患者可获得舒缓医疗服务[1]。

本专题将讨论美国之外的舒缓医疗及临终关怀服务。有关舒缓医疗更全面的综述参见其他专题。 (参见“亚专科舒缓治疗的获益、服务与模式”)

流行病学

舒缓医疗服务主要关注非传染性死因，世界范围内绝大多数死亡病例是由这些病因引起的[2]。在所有地区需接受舒缓医疗的成年人中，进展性非恶性疾病患者所占的比例最高，其次是癌症。但非洲是一个例外，在非洲HIV感染者/艾滋病患者是需进行舒缓医疗的最大群体[3]。世界卫生组织(World Health Organizatio, WHO)估计绝大多数(78%)需进行临终关怀的成年人来自中低收入国家[3]。与此类似，绝大多数(98%)在生命终末期需进行舒缓医疗的儿童也来自中低收入国家[3]。然而，在成年人中，可获得和使用舒缓医疗的比例最高人群来自收入较高的国家。

一项纳入230多个国家的研究对国际上舒缓医疗的可获得性进行了评估，该研究报道，58%的国家存在一个或多个舒缓医疗体系[4]。其他研究表明，仅在约30%-45%的国家中具有专业级别的舒缓医疗[5,6]。

             

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-15.
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