慢性阻塞性肺病運用肺部復健脫離呼吸器之護理經驗－個案報告

Nursing Experience of Pulmonary Rehabilitation for Ventilator Weaning in a Chronic Obstructive Pulmonary Disease Patient

郭喬閔(Chiao-Min Kuo) ； 蔡衣帆(Yi-Fan Tsai) ； 陳頌云(Sung-Yun Chen) ； 楊時芳(Shih-Fang Yang) ； 林美玲(Mei-Ling Lin)

《北市醫學雜誌》 15卷2期 (2018/06) Pp. 111-122

https://doi.org/10.6200/TCMJ.201806_15(2).0012

摘要

本篇描述一位罹患慢性阻塞性肺疾病個案給予肺部復健動脫離呼吸器之護理經驗。護理期間2016年8月1日至8月29日，採用Gordon十一項健康功能型態評估，透過照護、觀察、會談的方式收集資料，發現個案有三個主要健康問題為：（一）活動無耐力；（二）呼吸器戒斷反應功能失常；（三）焦慮。透過肺部復健活動訓練呼吸肌力，使個案每次吸氣量可由350ml增加至520ml，緩解活動無耐力，減少對呼吸器依賴時間；鼓勵個案表達感受，給予正向支持，介紹成功案例，並使用音樂介入讓個案放鬆，使焦慮指數由25分降為9分，並於8月29日成功脫離呼吸器。病情穩定後轉至普通病房，後續追蹤個案於9月10日出院，出院後由呼吸治療師及復健師和居家護理師依個案狀況每個月訪視1~2次以提供心肺復健運動及居家護理照顧指導。希望藉此照護經驗，提供日後照護此類個案之參考。

關鍵字

慢性阻塞性肺疾病 ； 活動無耐力 ； 呼吸器戒斷反應功能失常 ； 肺部復健 ； 焦慮

並列摘要

This report describes the nursing experience of pulmonary rehabilitation for weaning off ventilator in a patient with chronic obstructive pulmonary disease (COPD). The nursing period was from August 1 to August 29, 2016. The patient's health status was assessed by using the modified Gordon's health assessment verification, and two major health problems were identified: dysfunctional ventilator weaning response and activity intolerance. Pulmonary rehabilitation enhances lung ventilation and activity endurance. After exercises, the inspiratory volume were increased from 350ml to 520ml, the strength and endurance of the inspiratory muscle improved, and the ventilator-dependent times reduced. We also gave positive support and encouraged the patient to express his emotions, and self-selected music was played during the weaning process. His anxiety score on the Beck Anxiety Inventory (BAI) dropped from 25 to 9. The patient was successfully weaned off from the ventilator on August 29 and transferred to general ward on stable condition. The patient was discharged on September 10 from the hospital. Home-based pulmonary rehabilitation and home care were provided 1 to 2 times a month after discharge by respiratory therapists and physiotherapist and home nurses. We provide this clinical experience as reference for weaning off ventilator.

並列關鍵字

Chronic Obstructive Pulmonary Disease (COPD) ； dysfunctional ventilator weaning response ； activity intolerance ； pulmonary rehabilitation ； anxiety