胸腔微創手術個案之護理照顧－以內視鏡輔助肺葉切除術為例

Perioperative Nursing Care in Patients Undergoing Minimally Invasive Surgery: An Example of Video-Assisted Thoracoscopic Surgery

李薇莉(Weillie Lee) ； 簡湘潔(Hsiang-Chieh Chien) ； 李滿梅(Mon-Mei Lee) ； 熊德筠(Der-Yun Hsiung) ； 陳鳳櫻(Fong-Ying Chen) ； 江友馨(Yu-Hsin Chiang)

《榮總護理》 32卷3期 (2015/09) Pp. 231-236

https://doi.org/10.6142/VGHN.32.3.231

摘要

胸腔微創手術不僅減輕組織損傷、心肺效應、術後疼痛及縮短住院日數，也明顯提升病人的舒適與美觀。然而縮短的住院天數，加速病人與家屬面對術後自我照顧的時間，護理人員需要翻轉慣常的術後護理過程，期望在短時間內提升病人與家屬的術後調適能力。本文以內視鏡輔助肺葉切除術為例，說明手術流程，與單肺通氣麻醉對病人氧合、循環、皮膚、疼痛與腸胃道等反應之影響，及病人與家屬在手術前、後自我處理能力的困難。護理目標強調增進病人與家屬對手術、復原過程的瞭解；提供充足的疼痛處理，降低發生呼吸合併症，並預備其出院後自我處理的能力。

關鍵字

內視鏡輔助胸腔鏡手術 ； 單肺通氣 ； 手術前焦慮 ； 手術全期護理

並列摘要

Minimally invasive surgery (MIS) enhances patient comfort and accelerates the recovery process; however, shortened length of hospital stay increases self-management time for patients and their families. Nurses can efficiently enhance the self-management ability of patients and their families by remodeling the nursing care process according to MIS. This paper describes how videoassisted thoracoscopic surgery and one-lung ventilation can affect patients' oxygenation, circulation, skin, pain, and gastrointestinal responses and the difficulties that patients and their families face during perioperative periods. MIS nursing goals are to provide adequate pain management, facilitate recovery through oxygenation, minimize complications, and enhance the self-management ability of patients.

並列關鍵字

video-assisted thoracoscopic surgery ； one-lung ventilation ； preoperative anxiety ； perioperative nursing

參考文獻

鄭裕仁（ 2013）．三孔式全胸腔鏡肺葉切除手術治療肺癌．臺灣醫界， 56 (12)，33-36。

Bradshaw, W. A., Gregory, B. C., Finley, C.,Ross, A., Wilds, T., Still, M., & Smith,C. D. (2002). Frequency of postoperative nausea and vomiting in patients undergoing laparoscopic foregut surgery.Surgical Endoscopy and Other Interventional Techniques, 16(5), 777-780.

Hollings, D. D., Higgins, R. S. D., Faber, L.P., Warren, W. H., Liptay, M. J., Basu, S.,& Kim, A. W.(2010). Age is a strong risk factor for atrial fi brillation after pulmonary lobectomy. The American Journal of Surgery, 199(4), 558-561.

Imperatori, A., Rotolo, N., Gatti, M., Nardecchia,E., De Monte, L., Conti, V., & Dominioni,L. D. (2008). Peri-operative complications of video-assisted thoracoscopic surgery.International Journal of Surgery, 6(suppl 1),78-81.

Jordan, S., Mitchell, J. A., Quinlan, G. J.,Goldstraw, P., & Evans, T. W. (2000). The pathogenesis of lung injury following pulmonary resection. European Respiratory Journal, 15(4), 790-799.