照護一位會陰部壞死性筋膜炎個案之護理經驗

本文係一位32歲女性因福爾尼埃氏壞疽接受會陰部清創手術之護理經驗。此個案為發生於巴氏腺膿腫後，細菌經由外陰和會陰部傷口迅速進展的軟組織感染，由於會陰部是最私密之部位，且陰唇壞死性筋膜炎傷口位置不易察覺，細菌沿會陰部漫延並擴散至筋膜到周圍結構，導致血栓形成、缺血、組織壞死，若不控制即會休克和器官功能障礙，此疾病不易察覺，故惡化速度快且容易致死。照護期間為2017年11月24日至12月7日，運用Gorden十一項健康評估工具，採直接照護、身體評估、溝通會談等技巧收集與分析資料，發現個案有三項健康問題：急性疼痛、焦慮、組織完整性受損等：教導放鬆技巧減緩疼痛；適時提供現況資訊主動關懷，傾聽及同理個案表達其內心感受；評估及記錄傷口改善，嚴格遵守無菌技術原則執行換藥，促進傷口癒合。照護期間，個案因面臨福爾尼埃氏壞疽之高死亡率、抉擇接受結腸造口術、術後傷口劇烈疼痛及感染等問題所造成的身心壓力，並教育個案當會陰或生殖部位有感染現象時，要提高警覺，養成正確的生活作息、避免久坐，多活動改善局部循環。運用傾聽、不批判、主動陪伴關懷等，對於此個案須給予疼痛控制及心理支持，期望透過此次護理經驗分享，提供護理人員照護相關個案的參考。

關鍵字

福爾尼埃氏壞疽；疼痛；組織完整性受損；焦慮

並列摘要

This article describes a nursing experience of a 32 year old woman with Fournier's gangrene who underwent perineal debridement surgery. This case occurred after a Bartholin's cyst. Bacteria rapidly progressed through the soft tissue of the vulva and caused perineal wound infection. Because the perineum is the most private part, it was difficult to detect the position of the wound around the labia necrotizing fasciitis. The bacteria spread along the perineum and the surrounding structure and fascia, leading to thrombosis, ischemia, and tissue necrosis. If the disease was not well controlled, this would result in shock and organ dysfunction. Since the disease was difficult to detect, it deteriorated rapidly and was easy to cause death. Gordon's 11 Function Health Patterns Assessment criteria were used to evaluate the patients from November 24 to December 7, 2017. The health problems included acute pain, anxiety, and impaired tissue integrity. The case was taught relaxation techniques to reduce pain and provided timely status information about active care through listening and empathy to let her express her inner feeling with assessment and record about wound improvement, strictly complying with the principles of aseptic technique to facilitate wound healing. During the period of nursing care, the physical and mental pressure caused by the high mortality rate of Fournier's gangrene, the case chose colostomy surgery and underwent severe pain and infection of the wound after the operation. When the case is infected in the perineum or reproductive part, it is necessary to be vigilant, develop a correct daily routine, avoid prolonged sitting, and do more activities to improve local circulation. Using listening, non-judgment and active companionship and care, pain control as well as psychological support should be given to the case. It is hoped that through the sharing of nursing experience, it can provide reference for nursing staff to take care of related cases.

並列關鍵字

Fournier's gangrene ； pain ； impaired tissue integrity ； anxiety

參考文獻

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Beecroft, N. J., Jaeger, C. D., Rose, J. R., Becerra, C., Shah, N. C., Palettas, M. S., Lehman, A., Posid, T., Jenkins, L. C., & Baradaran, N. (2021). Fournier's Gangrene in Females: Presentation and Management at a Tertiary Center. Urology, 151, 113-117. https://doi-org/10.1016/j.urology.2020.05.056

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