一位脊椎壓迫性骨折行經皮椎體成形術之手術全期護理

A Perioperative Nursing Experience for a Compression Fracture with Percutaneous Vertebroplasty

張妤凡(Yu-Fan, Zhang) ； 楊曜蓮(Yao-Lian, Yang) ； 葉惠玲(Hui-Ling, Yeh)

《志為護理-慈濟護理雜誌》 21卷6期 (2022/12) Pp. 98-107

摘要

本文98歲女士2019年9月3日跌倒背部疼痛，確診脊椎壓迫性骨折行經皮椎體成行術之手術全期護理。護理期間自2019年10月1日至4日，藉由手術前後訪視、會談、身體評估及查閱病歷，運用Gordon十一項功能性健康型態，確立個案手術前焦慮、手術中急性疼痛、手術中低效性呼吸型態及手術後潛在危險性跌倒。手術前說明麻醉手術過程，提高認知；手術中因骨針置入疼痛，立即予麻醉止痛藥物，疼痛指數下降至2分；手術中血氧濃度下降立即告知醫師並提供鼻導管給氧，血氧濃度快速上升至95%；術後建議背架使用並漸進式下床，出院前無跌倒。希望藉由此照護經驗分享，提供臨床照顧年老局部麻醉手術個案之參考。

關鍵字

經皮椎體成形術 ； 低效性呼吸型態 ； 手術全期護理

並列摘要

This article describes a 98-year-old woman who fell on September 3, 2019. She had back pain and confirmed diagnose the spinal compression fracture and received surgery of percutaneous vertebroplasty. The nursing period ranged from 1 to 4 October, 2019. Data were collected by visits before and after surgery, interviews, physical assessments and medical records. Gordon's eleven functional health patterns assessment tools to establish problems. The major problems were preoperative anxiety, intraoperation acute pain and inefficient breathing pattern, and potentially dangerous falls after surgery. Explain the anesthesia and the surgical procedure to reduce anxiety before surgery. During the operation, the pain was intolerable due to the insertion of the bone needle, immediately assisted in the administration of anesthesia and analgesics, the pain score dropped to 2 points. When the blood oxygen concentration dropped, the doctor was notified and the nasal cannula was immediately provided for oxygen. The blood oxygen concentration promote to 95% quickly. It is recommended to use the back frame and gradually activity without falling during hospitalization. It is hoped that through this sharing of nursing experience, it can provide a reference for clinical care of elderly cases of local anesthesia surgery.

並列關鍵字

ineffective breathing pattern ； percutaneous vertebroplasty ； 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

洪政豪、蔡承憲、陳亮宇、彭莉甯(2017)．老年跌倒之評估、介入與預防．臺灣老年醫學暨老年學雜誌，12(2)，91-103。https://doi.org/ 10.29461/TGG.201705_12(2).0002

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

鄭宇文、任森利(2018)．新式椎體矯正支撐術於脊椎壓迫性骨折之應用．臨床醫學，81 (2)，69-71。https://doi.org/10.6666/ClinMed.201802_81(2).0013

Bach, J. (2017). A quick reference on hypoxemia. Veterinary Clinics of North America. Small Animal Practice, 47(2), 175–179. https://doi.org/10.1016/j.cvsm.2016.10.004