BACKGROUND:Lower extremity amputation is common among patients with ESRD, and often portends a poor prognosis. However, little is known about end-of-life care among patients with ESRD who undergo amputation. METHODS:We conducted a mortality follow-back study of Medicare beneficiaries with ESRD who died in 2002 through 2014 to analyze patterns of lower extremity amputation in the last year of life compared with a parallel cohort of beneficiaries without ESRD. We also examined the relationship between amputation and end-of-life care among the patients with ESRD. RESULTS:Overall, 8% of 754,777 beneficiaries with ESRD underwent at least one lower extremity amputation in their last year of life compared with 1% of 958,412 beneficiaries without ESRD. Adjusted analyses of patients with ESRD showed that those who had undergone lower extremity amputation were substantially more likely than those who had not to have been admitted to-and to have had prolonged stays in-acute and subacute care settings during their final year of life. Amputation was also associated with a greater likelihood of dying in the hospital, dialysis discontinuation before death, and less time receiving hospice services. CONCLUSIONS:Nearly one in ten patients with ESRD undergoes lower extremity amputation in their last year of life. These patients have prolonged stays in acute and subacute health care settings and appear to have limited access to hospice services. These findings likely signal unmet palliative care needs among seriously ill patients with ESRD who undergo amputation as well as opportunities to improve their care.
背景: 下肢截肢在 ESRD 患者中很常见，通常预示着预后不佳。然而，对于接受截肢的 ESRD 患者的临终关怀知之甚少。 方法: 我们对 2002年至 2014年死于 ESRD 的医疗保险受益人进行了一项死亡率随访研究，以分析与无 ESRD 的受益人的平行队列相比，在生命最后一年的下肢截肢模式。 ESRD。我们还研究了 ESRD 患者的截肢和临终关怀之间的关系。 结果: 总的来说，在 8% 名 ESRD 受益人中，754,777 的人在他们生命的最后一年接受了至少一次下肢截肢，相比之下，1% 名没有 ESRD 的受益人中，这一比例为 958,412。对 ESRD 患者的调整分析表明，那些经历了下肢截肢的患者比那些没有入院的患者更容易接受急性和亚急性护理设置在他们生命的最后一年。截肢也与在医院死亡的更大可能性、死亡前透析中断以及接受临终关怀服务的时间更少有关。 结论: 近十分之一的 ESRD 患者在其生命的最后一年经历了下肢截肢。这些病人在急性和亚急性医疗保健环境中停留时间较长，似乎获得临终关怀服务的机会有限。这些发现可能预示着接受截肢的 ESRD 重病患者未满足的姑息治疗需求，以及改善护理的机会。
Lower Extremity Amputation and Health Care Utilization in the Last Year of Life among Medicare Beneficiaries with ESRD.
截肢术是指经骨或关节将已丧失生存能力、危害病人生命和没有生理功能的肢体截除的外科手段，是一项破坏性的手术。 术前局部处理1.1 切开引流 必须充分暴露脓腔，将坏死组织包括肌腱清理干净。1.2 局部换药 （1）干性坏疽宜暂时用无菌敷料 (或酒精纱布)包扎。（2）湿性坏疽应先切开并用凡士林油纱填塞引流。（3）创面选择敏感的抗生素纱布湿敷。 截骨平面的确定截骨平面判定应考虑：（1）营养状况。若出现皮色苍白、皮温降低、肌肉软组织萎缩菲薄、汗毛脱落等征象，说明组织营养差，愈合不良。
Amputation 英 /ˌæmpjuˈteɪʃn/ 美 /ˌæmpjuˈteɪʃn/
释义 n. 截肢；切断（术）
例句 Until now, how amputation is translated into gene activation has been like magic. 迄今为止，截肢是如何被解释为基因活化仍像魔法一样。