降低血友病病人出血之發生率

Reducing the Incidence of Bleeding in Patients with Hemophilia

林美珍(Mei-Chen Lin) ； 蔡施變(Shih-Pien Tsai) ； 蔡佳蓉(Chia-Jung Tsai) ； 甘惠瑩(Hui-Ying Kan) ； 陳繼鳳(Chi-Feng Chen)

《高雄護理雜誌》 35卷2期 (2018/08) Pp. 24-36

https://doi.org/10.6692/KJN.201808_35(2).0003

摘要

近年來為使血友病病人能從出血時注射轉為預防性注射凝血因子，從定期接受凝血因子注射治療117位病人中，有36位病人(30.8%)發生出血情形，成立專案小組。問題中發現：自認為能判斷出血狀況而自行增減藥物劑量(認知層面)；碰撞、運動、工作及營養不均衡時易造成出血(個人因素)；出血時不會立即自我注射(處置行為)；衛教不落實、相關知識不足（醫療人員）等因素，從2014年12月16日至2015年7月31日期間成立跨醫療團隊舉辦團體衛教、修訂衛教手冊、製作衛教光碟及教導居家自我注射等措施，改變病人行為，出血發生率下降至13.7%，其中20位出血病人轉為預防性注射，提升用藥安全及降低異常出血之傷害，冀望本專案之改善經驗可作為照顧血友病病人之參考。

關鍵字

血友病 ； 遵從性 ； 醫療人員的認知

並列摘要

In recent years, preventive injection has been promoted to mitigate bleeding in hemophilia patients. From regular injections of coagulation factor, in a group of 117 patients, 36 patients (30.8%) had such a bleeding situation. A team was established, and the following problems were found (as percentages): patients able to judge bleeding status (77.8%), their voluntary increase or decrease of dose (38.9%), bleeding did not lead to immediate self-injection (77.8%) and health providers thinking that they provided enough health education messages in current health education manuals (75%). Therefore a cross-medical team was established focusing on health education for groups, revision of the health education manual, making a health education DVD, and teaching how to self-inject in home. This intervention changed patient behavior, and with an implementation of 7.5 months, bleeding rate dropped to 13.7%, of which 20 (out of the original 36) patients hemorrhaged into preventive injection, improved drug safety and reduced injuries from abnormal bleeding. The authors hope to recommend the experience of this project as a reference to nursing care of patients with hemophilia.

並列關鍵字

hemophilia ； compliance ； self-injection

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