一項研究發(fā)現(xiàn)：醫(yī)生很少與病危患者探討植入式電除顫器的問題，所以許多患者在即將死亡的最后數(shù)日、數(shù)小時或者數(shù)分鐘內仍然反復接受電除顫器的電休克。

在生命最后階段，電除顫電休克導致患者不適、焦躁以及死亡時間延長。在該項研究中研究人員發(fā)現(xiàn)：在100例終末期患者中只有27例討論關閉電除顫器。在這27例患者中，有21例患者或者家屬決定關閉電除顫器。即使這些要求撤除電除顫器的患者中，仍然少于45％的患者討論繼續(xù)使用除顫器。

另外一項相關報道是：在100例患者中有超過四分之一的患者在生命的最后數(shù)月內接受電除顫器電休克，百分之三十在生命最后數(shù)分鐘內接受電休克。這項研究結果報道于2004年11月7日《內科學年報》。

西奈山醫(yī)學院成人發(fā)育與老年病科助理教授、首席研究員Nathan Goldstein醫(yī)生說：“在心衰或者生命只剩下數(shù)月或者數(shù)年患者中，電除顫挽救了數(shù)以千計的生命。但是這項研究使醫(yī)生明白，當患者已經(jīng)只剩下數(shù)日或者數(shù)周生命的時候，應當討論持續(xù)使用電除顫器的正面與反面后果。”

Palliative Care for Defibrillator Patients
 
A study has found that doctors rarely discuss implanted defibrillators with their sickest patients, so many of them undergo repeated defibrillator shocks during their last days, hours, or minutes of life as they are dying.

At that late stage of life, defibrillation shocks cause discomfort, anxiety, and a prolonged death. In the study, researchers found that discussions about deactivating defibrillators took place in only 27 of 100 cases of terminally ill patients. Among these 27 patients, 21 patients or family members decided to deactivate the defibrillator. Even among patients with do-not-recuscitate (DNR) orders, discussions about continued use of the defibrillator occurred in fewer than 45% of cases.

Next of kin reported that more than one-quarter of the 100 patients received a shock from the defibrillator in the last month of life, and 30% of that group received a shock in the last minutes of life. The study findings were reported in the December 7, 2004, issue of the Annals of Internal Medicine.

“Among patients with heart failure and months or years to live, defibrillators save thousands of lives,” said lead investigator Nathan Goldstein, M.D., assistant professor, department of geriatrics and adult development, Mount Sinai School of Medicine (New York, NY, USA). “However, this study makes clear that physicians should talk about the pros and cons of continuing the device when patients are approaching the last days or weeks of life.”