一位子宮破裂併發嚴重出血產婦之生產照護經驗

Nursing Experience of a Multipara with Uterine Rupture Complicated by Postpartum Hemorrhage

林思妤(Szu-Yu Lin) ； 林玉蘭(Yu-Lan Lin)

《榮總護理》 36卷4期 (2019/12) Pp. 368-375

https://doi.org/10.6142/VGHN.201912_36(4).0005

摘要

子宮破裂是產科罕見急症，往往造成大量出血，嚴重威脅產婦生命。本文描述一位經產婦在生產時因子宮破裂導致大量出血之生產照護經驗。照護期間為2018年5月23日至5月24日，於產房自然生產過程以及兩次的緊急剖腹探查手術，筆者運用羅氏適應模式進行評估，藉由觀察、傾聽、會談及病歷回溯等方式，確立個案有體液容積缺失、高危險性傷害、創傷後壓力、身體心像改變的健康問題。護理過程秉持家庭為中心的護理理念，在個案生產後出血的當下，穩定生命徵象及血液動力學；在個案轉危為安時，利用傾聽、關懷個案與先生抒發對生產過程的感受，提供子宮切除相關照護與指導，陪伴個案及家庭走過生產創傷，並貼心安排出院慶祝會。建議往後醫療團隊定期安排產後大出血相關在職教育訓練，提升專業知能，使同仁能從容應對子宮破裂及產後出血，以提供更安全高品質的生產照護，並持續給予生育家庭支持性照顧。

關鍵字

子宮破裂 ； 產後出血 ； 生產創傷

並列摘要

Uterine rupture is a rare but life-threatening obstetric emergency, frequently resulting in massive bleeding. This article describes the nursing experience of a patient who had postpartum hemorrhaging due to uterine rupture. The direct nursing care was required from May 23 to 24, 2018, including vaginal delivery and two exploratory laparotomy surgeries. The author used Roy's adaptation model by observing, interviewing, listening, and performing chart review to evaluate the patient's health problems, including fluid volume deficit, high risk of injury, post-trauma response, and body image disturbance. During the nursing case, vital signs and hemodynamics were managed in a family-centered manner. When the patient's condition stabilized, nursing care focused on listening and empathizing with the patient, allowing the patient and her family to describe how they feel during care, and providing postoperative care. Moreover, a party celebrating the patient's discharge was arranged to help her process the traumatic events. We suggest that regular training programs be held to prepare our medical team for such an emergency. This may enable them to provide safe and high-quality delivery nursing care and provide the patients' families with improved supportive care.

並列關鍵字

uterine rupture ； postpartum hemorrhage ； traumatic birth experiences

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