照顧一位巨大肝血管瘤病患行體外自體肝臟移植手術全期護理經驗

A Perioperative Nursing Experience of Autologous Liver Transplantation for a Patient with Huge Hepatic Hemangioma

王珮如(Pei-Ru Wang) ； 李姿賢(Zi-Xian Li) ； 楊惠琄(Hui-Chuan Yang)

《彰化護理》 26卷1期 (2019/03) Pp. 41-55

https://doi.org/10.6647/CN.201903_26(1).0008

摘要

本文探討一位巨大肝血管瘤病患行『體外自體肝臟移植』手術全期護理經驗，筆者為肝臟移植小組之手術全期護理師，由於體外自體肝臟移植手術的困難度相當高，尤其在手術全期護理不常見，引發想深入探討此類手術病患之動機。筆者於2017年7月11日至7月24日住院期間，以Gordon十一項功能性健康型態為評估工具，經觀察、手術前後訪視、病歷閱讀等方式收集資料，確立病患有焦慮、潛在危險性手術情境的傷害、高危險性體溫過低及疼痛。在手術全期護理過程中，筆者藉由手術前訪視，發現病患對於自己即將面臨此次高風險手術感到極度焦慮及不安，提供手術前準備相關訊息，運用傾聽及同理心鼓勵病患表達心中感受。手術中期依照標準作業流程維護病患手術安全，避免潛在危險性傷害發生，給予適當的保暖措施避免病患於手術中低體溫。手術後教導個案減輕傷口疼痛方式及傷口照護衛教等。筆者希望能藉由此次護理經驗，了解病患的需求，提早給予病患合適的衛教與準備，以減少手術前焦慮及手術後合併症情形，進而達到手術全期護理之目的。

關鍵字

巨大肝血管瘤 ； 自體肝臟移植 ； 低體溫

並列摘要

This article is an attempt to discuss a perioperative nursing experience of autologous liver transplantation for a patient with huge hepatic hemangioma. The author is a perioperative nurse from a liver transplantation team. Since autologous liver transplantation is relatively uncommon and the high degree of difficulty, it motivates the author to conduct this study. During the period from July 11th 2017 to July 24th 2017, data and information were collected through observation, prior and after operation visits, and chart review. After applied Gordon's 11 Functional Health Patterns Assessment, the possibility of patient anxiety, potentially hazardous surgical situations, risk of hypothermia and pain were identified. Upon preoperative visit, the author found that the patient was extremely anxious about his upcoming high-risk surgery. The author managed the situation by providing information related to preoperative preparation and encouraging the patient to express his feeling and showing sympathy to him. During the surgery, the surgical safety was maintained through standard operating procedures in order to avoid potential injuries. Adequate temperature control was provided, preventing the patient from hypothermia. The author educated the case about wound care and appropriate methods to reduce pain in postoperative period. Through this experience, the author understands in order to achieve a quality perioperative nursing care, it is imperative to recognize the need of patient. Moreover, giving related education and preparation to patient in an earlier time can assist on reducing preoperative anxiety and postoperative complications.

並列關鍵字

Huge hepatic hemangioma ； Autologous liver transplantation ； Hypothermia

參考文獻

李秋香、顏文娟、林淑貞、徐彩育、賴慶祥(2014)‧音樂介入對脊椎手術病人術前焦慮之影響‧榮總護理，31(4)，343-351。

黃瓊慧、吳貞慧、張怡華、賈如瓊、張璇其、洪曉佩(2017)‧全身麻醉病人術後介入保暖措施改善低體溫之成效探討‧健康與建築雜誌，4(2)，88-94。Doi：10.6299/JHA.2017.4.2.R10.88

謝佳恩、陳堯俐(2017)．認識部分活動捐贈及肝臟移植手術．血管醫學防治季刊，28，17-19。Doi：10.6527/PVM.2017.28.7

Julian, L. J. (2011). Measures of Anxiety. Arthritis Care Res, 63, 0-11. doi:10.1002/acr.20561

Madrid, E., Urrútia, G., Roqué i Figuls, M., Pardo-Hernandez, H., Campos, J. M., Paniagua, P., …& Alonso-Coello P. (2016). Active body surface warming systems forpreventingcomplications caused by inadvertent perioperative hypothermia in adults. Cochrane Database Systematic Reviews, 4, CD009016. doi: 10.1002/14651858.CD009016.pub2.