照護一位肺動脈肉瘤患者術後使用葉克膜之加護經驗

An Intensive Care Experience of a Pulmonary Artery Sarcoma Patient after Surgery on ECMO

葉郁文(Yu-Wen Yeh) ； 董育秀(Yu-Hsiu Tung)

《安泰醫護雜誌》 18卷3期 (2012/09) Pp. 31-50

https://doi.org/10.7078/TSMHMNJN.201209.0031

摘要

個案為臨床罕見的肺動脈肉瘤患者，初期診斷肺栓塞，行切除手術中因肺動脈高壓裝置葉克膜，術後病理切片確診為惡性腫瘤，個案面臨比預期嚴重的病況，心理承受極大壓力，且對未來充滿不安；筆者於術後急性加護期照護此個案，護理期間為2009.06.18～2009.06.30，運用羅氏適應模式進行護理評估，確立下列健康問題：（1）高危險性傷害/出血（2）體液容積過多/腎臟組織灌流改變（3）無力感/失去身體自主權（4）睡眠形態紊亂/環境干擾；藉著護理計畫、護理措施之執行，早期預防合併症的產生，協助個案參與治療計畫，使其產生信心，以重建角色關係，讓個案可勇於面對未來的療程。期盼藉由此個案報告之撰寫，讓未來面對此一罕見疾病患者照護時，可作為參考，以提昇加護照護之品質。

關鍵字

肺動脈肉瘤 ； 肺栓塞 ； 體外循環系統 ； 葉克膜

並列摘要

We report a rare case of pulmonary artery sarcoma in a man who had pulmonary embolism in the primary stage. After surgery, the patient received extracorporeal membrane oxygenation because of pulmonary hypertension. His conditions were more serious than predicted, and when the diagnosis of a malignant tumor was made, he was extremely worried about his future. We applied Roy's adaptation model of nursing to evaluate this patient in the intensive care unit. The nursing period was from June 18, 2009 to June 30, 2009. Assessment of the obtained data revealed that the main problems in nursing care of the patient were risk of bleeding, excess fluid volume, powerlessness, and disturbed sleep pattern. With an appropriate nursing program, primary prevention can avoid the occurrence of complications. In our case, nursing assistance helped the patient develop a positive approach toward treatment and rebuild self-confidence. This also involved building a good relationship with the patient and his family. We share our experience in this case in the hope that it will serve as a future reference for nursing staff and help enhance intensive care experiences.

並列關鍵字

Pulmonary artery sarcoma ； pulmonary embolism ； Extracorporeal membrane oxygenator ； ECMO