一位創傷性主動脈剝離患者之護理經驗

個案因車禍併發B型主動脈剝離，在臨床上為罕見案例，故引發筆者探討的動機。本文描述一位創傷性主動脈剝離患者之護理經驗，照護期間為2020年11月12日至2020年11月21日，運用Gordon十一項功能性健康型態進行評估及分析，藉由觀察、照護個案以及病歷查閱等方式收集資料，確立健康問題為『急性疼痛』、『焦慮』、『潛在危險性創傷後症候群』及『活動無耐力』。個案因B型主動脈剝離於胸主動脈行支架放置術，對於術後傷口疼痛之問題，教導個案減輕疼痛之技巧，以減緩疼痛情況；因疾病導致無法勝任工作使個案焦慮，給予個案傾聽及陪伴，並教導可使用放鬆技巧以降低焦慮感；個案遭遇一場嚴重車禍，於照護過程發現個案有潛在危險性創傷後症候群，鼓勵個案說出對車禍的感受，與個案一起探討減少創傷性反應的策略，教導家人適時陪伴，給予個案安全感。住院期間提供個案照護指導，同時給予個案希望，滿足心理需求，鼓勵正向思考模式，降低個案發生創傷後反應，協助個案返家後的自我調適能找到平衡點。希望藉此個案照護經驗，作為日後照護此類病人之參考。

關鍵字

主動脈剝離；潛在危險性創傷後症候群；焦慮

並列摘要

The motivation of this article was because the patient had type B dissection caused by the car accident, which was rare in clinical practice. This article described a nursing experience of an aortic dissection patient with potential posttraumatic stress disorder, from Nov. 12th to 21st in 2020. Gordon's 11 functional health patterns were used to point out the health problems with acute pain, anxiety, potential PTSD, and activity intolerance. In order to relieve her chest pain, we taught her some skills to relieve the pain. As to her anxiety, we listened to her attentively and taught her many ways to reduce her worries. The patient suffered from a severe car accident, and after we found that she had a potential PTSD, we encouraged her to talk about the feeling with us and taught her family to keep her company. In addition, we discussed the strategy of how to reduce the trauma reaction together. We provided nursing instructions and gave her hope to encourage her to think positively. Furthermore, we helped her find the balance of her life. Finally, a nursing experience of an aortic dissection patient with potential PTSD could give reference in the future.

並列關鍵字

aortic dissection ； potential PTSD ； anxiety

參考文獻

車先蕙、盧孟良、陳錫中、張尚文、李宇宙（2006）‧中文版貝克焦慮量表之信效度‧臺灣醫學，10（4），447-454。https://doi.org/10.6320/FJM.2006.10(4).05

范雅芬、簡媜彥、楊惠媛、蔡榮美（2014）‧血管腔內主動脈瘤修復手術（EVAR）的護理‧護理雜誌，61（2），95-100。https://doi.org/10.6224/JN.61.2.95

Chang, J. T., & Lin, Y. C. (2019). Acute type b aortic dissection with right hemothorax. Journal of Medical Sciences, 39(3), 140-142. https://doi.org/10.4103/jmedsci.jmedsci_136_18

Chao, S. F., & Chang, B. S. (2004). Blunt traumatic rupture of the aorta. Tzu Chi Medical Journal, 16(3), 137-142. https://doi.org/10.6440/TZUCMJ.200406.0137

Lee, W. C., Shih, M. C., Lin, H. L., & Cheng, Y. C. (2010). Traumatic dissection of a renal artery branch after blunt abdominal trauma: A case report and review of the literature. Journal of Emergency and Critical Care Medicine, 21(2), 94-98. https://doi.org/10.30018/JECCM.201006.0005

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