一位急性呼吸窘迫病人接受俯臥通氣治療之加護經驗

本文為描述一位因肺炎嚴重進展至急性呼吸道窘迫症候群，首次置入氣管內管合併呼吸器使用，於加護病房輔以俯臥通氣治療之照護經驗。護理期間自2019年3月22日至4月18日，運用生理、心理、社會及靈性四個層面評估，以觀察、身體評估、查閱病歷、與病人及家屬會談等方式，確立個案有氣體交換功能障礙、高危險性皮膚完整性受損、焦慮等健康問題。以俯臥治療改善氧合功能，提供輔具避免皮膚受壓，給予預防管路滑脫之照護，過程中運用同理心、陪伴傾聽，與病人及家屬建立良好的護病關係，給予個別性護理措施，以降低焦慮不安感。在醫護團隊共同努力下成功脫離呼吸器，期望藉此照護經驗與同仁分享，作為日後照護類似個案之參考。

關鍵字

急性呼吸道窘迫症候群；俯臥通氣治療；焦慮

並列摘要

This article describes the care experience of prone ventilation adopted in the ICU for one patient with ARDS caused by severe pneumonia receiving endo-tracheal intubation with mechanical ventilator use. During the period from 22th March to 18th April, 2018, the author collected the data from different aspects, including observations, physical assessments, medical clinical records and family conference. The major health problems included impaired gas exchange, high risk of skin defect and anxiety disorder. Prone ventilation was adopted to improve oxygenation, assistive devices were provided to decrease skin pressure, all in order to prevent unplanned extubation. Communication skills including empathy, company and listening to establish good relationship between nurse and patient were used, and individual nursing intervention was offered to decrease anxiety. Under multidisciplinary teamwork, patient was extubated successfully. This experience is shared as a reference for nursing professionals.

並列關鍵字

acute respiratory distress syndrome ； prone ventilation ； anxiety

參考文獻

呂淑如、王筱珮(2018)．俯臥通氣治療及其護理．護理雜誌，65(3)，96-102。https://doi.org/10.6224/ JN.201806_65(3).13

李柏昕、王振宇、黃彥翔、李博仁、傅彬貴(2019)．急性呼吸窘迫症候群使用俯臥式通氣模式之預後影響因子探討．內科學誌，30，96-106。https://doi.org/10.6314/JIMT.201904_30(2).06

施純瑩(2019)．重症患者的疾病詮釋、壓力與焦慮之相關研究．［未發表之碩士論文］．中山醫學大學。台灣碩博士論文系統。

許建威、陳垚生 (2017)．預防呼吸器相關性肺炎組合式照護．內科學誌，28(1)，18-23。https://doi.org/ 10.6314/JIMT.2017.28(1).04

張惠君、簡慧足、胡月娟(2014)．俯臥對加護病房急性呼吸窘迫症候群病人之氧合與合併症成效—系統性回顧暨統合分析．護理暨健康照護研究，10(3)，178-189。https://doi.org/10.6225/JNHR.10.3.178

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一位急性呼吸窘迫病人接受俯臥通氣治療之加護經驗

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