脫離體外維生系統輔助治療後患者常見問題與護理

Health Problems and Nursing Care in Patients after Extracorporeal Life Support

陳綱華(Kang-Hua Chen) ； 林琬容(Wan-Jung Lin) ； 商舒婷(Shu-Ting Shang)

《長庚護理》 32卷1期 (2021/03) Pp. 32-44

https://doi.org/10.6386/CGN.202103_32(1).0003

摘要

體外維生支持系統廣泛地應用於心、肺衰竭與休克患者，提供受損器官充裕的恢復時間提高存活機率。但相關治療合併症所遺留的長期傷害（例：神經系統障礙、末端肢體缺血和腎臟功能受損），及因治療環境所引發的心理問題，使患者即使在體外維生支持系統移除後，仍會持續面臨到生理及心理上的不適，衍生社會經濟層面的問題。「關懷」是護理的核心價值，醫療人員關注患者存活率的同時，護理人員不可忽視全人照護的重要。本文除說明接受體外維生支持系統輔助治療期間患者常見合併症，亦針對脫離維生系統後之身、心、社會問題提出護理處置，期望提供護理人員照顧此類患者之參考，提升長期生活品質。

關鍵字

體外維生支持系統 ； 體外膜氧合 ； 護理

並列摘要

Extracorporeal life support (ECLS) has become widely used in patients who suffer from heart and lung failure and shock. ECLS provides more time for damaged organs to recovery, thereby increasing survival rates of patients. However, treatment-related complications (eg, neurological complications, lower extremity ischemia, or kidney injury) and environment-induced psychological problem may lead to physical and psychological discomforts even when patients have weaned ECLS, and result in socioeconomic problems. Caring is the core value of nursing. While healthcare professionals concern about increasing survival rates of patients, nursing staff cannot ignore the importance of holistic care. This article describes the complications during ECLS support and also proposes the physical and psychosocial nursing management after weaning ECLS. We expect to provide nursing staff with references for caring such patients and improve the patient's long-term quality of life.

並列關鍵字

extracorporeal life support ； extracorporeal membrane oxygenation ； nursing

參考文獻

柯文哲 (2010)．葉克膜 (ECMO) 的倫理問題．澄清醫護管理雜誌，6(2)，4-7。[Ko, W. J. (2010). Ethical issues of ECMO. Cheng Ching Medical Journal, 6(2), 4-7. doi: 10.30156/CCMJ.201004.0001]

蔡宗諭、林展宇、陳永昌 (2015)．葉克膜病患合併急性腎損傷．腎臟與透析，27(4)，192-196。[Tsai, T. Y., Lin, C. Y., Chen, Y. C. (2015). Acute kidney injury in patients on extracorporeal membrane oxygenation. Kidney and Dialysis, 27(4), 192-196. doi: 10.6340/KD.2015.27(4).07]

Askenazi, D. J., Selewski, D. T., Paden, M. L., Cooper, D. S., Bridges, B. C., Zappitelli, M., & Fleming, G. M. (2012). Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation. Clinical Journal of the American Society of Nephrology, 7(8), 1328-1336. doi: 10.2215/CJN.12731211

Bakhtiary, F., Keller, H., Dogan, S., Dzemali, O., Oezaslan, F., Meininger, D., Ackermann, H., Zwissler, B., Kleine, P., & Moritz, A. (2008). Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: Clinical experiences in 45 adult patients. The Journal of Thoracic and Cardiovascular Surgery, 135(2), 382-388. doi: 10.1016/j.jtcvs.2007.08.007

Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., Peitz, G. J., & Ely, E. W. (2012). Critical care nurses’role in implementing the “ABCDE bundle”into practice. Critical Care Nurse, 32(2), 35-47. doi: 10.4037/ccn2012229