- 期刊
降低燒傷中心頭頸部癌症病人顯微游離皮瓣術後之譫妄發生率
A Project of Reducing the Incidence of Post-operated Delirium for Head and Neck Cancer Patients with Microsurgical Free Flaps in a Burn Center
摘要
頭頸部癌症病人接受顯微游離皮瓣重建手術後，為監測組織灌流而入住燒傷中心，病人因住隔離空間、無家人陪伴，恐慌不安而發生譫妄，極易影響手術結果。本單位2013年7月至12月入住的術後病人57位，有33位發生譫妄，發生率57.8%，3位病人因譫妄導致皮瓣重建失敗。因此，本專案目的為降低燒傷中心頭頸部癌症病人顯微游離皮瓣術後之譫妄發生率。執行方案包括制定入住燒傷中心及探訪注意事項、舉辦譫妄在職教育並提供譫妄護理，宣導使用譫妄評估表、提供術前衛教、燈光控制、更改家屬訪視作業及擦澡時段等。2014年11月至2015年3月43位病人，7人發生譫妄，發生率降至16.3%，無皮瓣重建手術失敗；2015年4月至9月共收案39人，2人發生譫妄，發生率為5.1%，皮瓣重建手術失敗一人。本專案除改善病人譫妄情形，亦提升同仁處理譫妄之能力，期透過此專案與同仁分享照護經驗。
並列摘要
The purpose of this project is to reduce the incidence of post-operated delirium for head and neck cancer patients with microsurgical free flaps in a burn center. Head and neck cancer patients with microsurgical free flaps often needed to be transferred in the burn center to monitor the post-operated flaps tissue perfusion. However, patients are easily anxious and delirious because of the spatial isolations. From 2013 July to December, the incidence of post-operated delirium was 57.8% of 57 patients and three operated flaps were failure. We designed the education leaflets, precautions, a delirium education program of the confusion assessment for the intensive care unit (CAM-ICU), provided the pre-operation education, closed fluorescent light at night, revised the visit rules and bath timing. From November 2014 to March 2015, the incidence of post-operated delirium was decreased to 16.3% and all 43 patients who had no failure flaps. The incidence of post-operated delirium was also maintained 5.1% during the next six months. In conclusions, this project is to improve post-operated delirium for patients with flaps and share this successful experience with clinical nurses to care the post-operative delirium patients with microsurgical free flaps.