食道靜脈瘤出血病患照護成效之影響因素

Factors Influencing the Effectiveness of Health Care for Esophageal Variceal Hemorrhage Patients

何修嫺(Shiou-Shyan Ho) ； 何京鰲(Ching-Ao Ho) ； 何美瑤(Mei-Yao Ho) ； 鄭婷霞(Ting-Hsia Cheng) ； 蔡騌圳(Tzung-Jiun Tsai)

《榮總護理》 33卷1期 (2016/03) Pp. 21-31

https://doi.org/10.6142/VGHN.33.1.21

摘要

食道靜脈瘤是肝癌及肝硬化主要合併症，急性出血死亡率高，易復發，是嚴重急症。研究目的在探討食道靜脈瘤出血病患照護成效的重要預測因子，作為醫療人員照護計畫參考。採病歷回溯之描述性研究，於南部某醫學中心以肝硬化或肝癌合併食道靜脈瘤出血，接受樣本醫院標準處置流程及照護的住院病患為對象。2008至2012年共817人，不重覆收案，食道球及食道靜脈瘤結紮僅41人，每年隨機取樣37位食道靜脈瘤結紮185人，共計226人。結果顯示42天再出血率重要危險因子為年齡、白蛋白、檳榔、肝癌、肝性腦病變、腹水、感染、肝硬化嚴重度、治療方法及是否使用預防再出血藥物，共可解釋21.8%的變異量，其中感染、治療方法、預防再出血藥物是重要預測因子，食道球不良反應主因與食道球壓力及深度有關，共可解釋45.3%的變異數。影響食道靜脈瘤出血照護成效之危險因子與肝功能障礙有關，宜積極宣導肝病防治，持續預防感染，以降低再出血率，預防再出血用藥者，護理指導單張宜增列及強調勿任意停藥，避免反彈性出血。建議食道球技術規範載明食道球壓力由有效壓力之最小壓力開始，視病況調整壓力，以杜絕壓力過高導致不良反應。

關鍵字

食道靜脈瘤 ； 照護成效 ； 影響因素

並列摘要

Background: Esophageal varicose (EV) is a major complication of hepatoma and liver cirrhosis, and acute EV bleeding produces high mortality and has a high recurrence rate. Purpose: To investigate the factors infl uencing the effectiveness of care for patients presenting with EV bleeding to serve as a reference for future care. Methods: This retrospective descriptive study with chart review was conducted at a medical center in Southern Taiwan. The samples were obtained from inpatients diagnosed with cirrhosis or hepatic cell carcinoma combined with EV bleeding during a standard treatment procedure: 817 cases from 2008 to 2012 were included without repetition. Only the patients in 41 cases were treated using both balloon tamponade and esophagus variceal banding ligation (EVL). In addition, stratified sampling was performed for 37 cases per year; thus, 185 patients undergoing EVL treatment were recruited. In total 226 patients were finally enrolled. Results: The adverse effects of balloon tamponade were increased pressure and depth, resulting in 45.3% variances. Predictors of rebleeding within 42 days were infection, total bilirubin, cirrhosis severity, treatment method, and EV color, resulting in 21.8% variance. Conclusions and Implications for Practice: The major factor infl uencing the effectiveness of care for EV bleeding was liver dysfunction. A health care policy should aggressively advocate prevention of liver disease, hepatic encephalopathy, and infection to reduce rebleeding and mortality rates. Patient education should emphasize preventive EV bleeding, and medicine should not be discontinued for preventing rebleeding. Balloon tamponade should be started from the lowest pressure and then adjusted according to the clinical condition for preventing an adverse reaction.

並列關鍵字

esophageal varix ； effectiveness of care ； factor

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