一位頸椎脊髓損傷行脊髓電刺激術之手術全期護理

本文是照護一位51歲男性，2018年11月因衝浪活動導致頸椎脊髓損傷併雙上肢麻刺痛、左上肢肌力3分、左下肢肌力4分，入院接受脊髓電刺激手術，期望恢復左側肢體肌力之手術全期護理經驗。護理期間自2020年06月02日至06月25日，以Gordon十一項功能性健康型態模式評估，並運用訪視、病歷查詢、實際照顧、身體評估、會談及出院後電話訪視等方式收集資料，確立個案有焦慮、潛在危險性損傷、身體活動功能障礙等健康問題。術前訪視時，個案因過去麻醉後拔管經驗不佳，故陪同聆聽麻醉醫師說明麻醉過程及風險評估，若有不懂之處筆者再加以解釋，此外請醫師告知此手術成功率，提高手術認知進而減緩焦慮；手術中保護個案身體易受壓部位，給予合適脂肪墊及柔軟布單加以防護，且提供溫棉被維持個案體溫在36-36.5度，避免手術過程體溫過低；手術後開啟電池雙上肢麻刺與疼痛感降至2分，左手肌力提升至4分，雙下肢肌力不變，但走路不再搖晃，出院後持續電話訪視，關心個案返家後身體活動功能狀況。建議醫院網站可設置手術及照護資訊，個案可利用3C產品隨時閱讀，減輕對手術的疑慮及焦慮。期望此照護經驗提供日後照顧類似個案之臨床經驗分享。

關鍵字

脊髓損傷；脊髓電刺激術；手術全期護理

並列摘要

This article is about perioperative nursing care provided to a 51-year-old man who had a cervical spinal cord injury from surfing in November 2018. He experienced tingling pain in both upper limbs, and his muscle strength in the left upper and lower limb was 3 and 4 points. He was admitted to the hospital for spinal cord stimulation and hoping to restore left limb muscle strength. The nursing period started from June 2nd to the 25th in 2020, where the patient was evaluated through visits, medical record inquiries, care provision, physical assessment, interviews, and post-discharge telephonic assessments with Gordon's Eleven Functional Health Assessment Model. The collected data indicated health problems such as anxiety, potential risk of injury, and physical activity dysfunction and so on. During the preoperative visit, the author accompanied the patient to listen to the anesthesiologist in order to understand the risks and steps of the anesthesia procedures to overcome the ill extubation experiences in the past. The author also provides further clarifications when the patient didn't understand something. Moreover, the doctor informed the patient about the success rate of the operation to facilitate surgical cognition and relieve anxiety. Suitable fat pads and soft cloth sheets were provided to protect the vulnerable parts of the patient's body during the operation and warm quilts were used to maintain the body temperature at 36-36.5 degrees to avoid hypothermia; the battery was switched on after the operation, the pain and tingling in both the upper limbs decreased to 2 points, and left-hand muscle strength increased to 4 points; the muscle strength of both the lower limbs remained unchanged, however the swaying of the limbs stopped when walking. Telephonic interviews were continued after discharged from hospital to follow up on the patient's functioning and physical activity after returning home. Hospital websites was established as suggested for surgery and care information so patients can access the internet with their electric gadgets to reduce their doubts and anxiety about procedures. It is hoped that by sharing this experience, it will provide a clinical reference for future nursing care with similar patients.

並列關鍵字

cervical spinal cord injury ； spinal cord stimulation ； perioperative nursing

參考文獻

林麗華、莊馥蓮、劉秋玉、吳幸芬、唐苡甄（2016）．某醫學中心手術臥位與手術壓瘡嚴重度之分析．榮總護理，33(1)，1-8。https://doi.org/10.6142/VGHN.33.1.13

林雅雯、李慧芝、李靜芳（2020）．結合復健資源提升內科加護病房足部復健運動執行率．領導護理，21(2)，116-127。https://doi.org/10.29494/LN.202006_21(2).0010

洪曉佩、曾麗華、雍允雯、林素萍、黃瓊慧、明金蓮（2019）．術前焦慮概念分析．榮總護理，36(2) ， 212-219 。 https://doi.org/10.6142/VGHN.201906_36(2).0011

莊佳雯、曹芳馨、楊斐茹、王郁婷、吳雅婷、邱燕甘（2017）．運用跨團隊共同照護網降低住院病人傷害性跌倒發生率．長庚護理，28(4) ， 640-653 。 https://doi.org/10.3966/102673012017122804006

陳美菊、龔秀華、湯玉珊、簡麗瑜（2016）．改善骨科手術前病人焦慮程度之專案．長庚護理，27(2) ， 197-208 。 https://doi.org/10.3966/102673012016062702005

主題瀏覽