一位接受跳動式冠狀動脈繞道手術病患之護理經驗

本篇個案報告是探討一位急性心肌梗塞個案，因胸悶不適、呼吸喘症狀入院後，檢查發現LAD、RCA & LMCA有90%堵塞，故決定採不使用體外循環之冠狀動脈繞道手術治療，術後轉至加護病房繼續治療，護理期間為2007年5月12日至5月16日，筆者是以身體評估、觀察及會談方式等方式收集與分析資料，確立個案之問題有輸出量減少、焦慮、營養型態改變及高危險性感染等，藉由多項護理措施的執行如：監測傷口之變化及觀察個案有無感染症狀，並隨時監測個案生命徵象之變化及降低個案焦慮、減輕傷口疼痛、詳細告知個案非傳統式冠狀動脈繞道手術相關知識、加護病房的環境介紹及後續照護等，協助個案及家屬迎接疾病挑戰，使個案轉危為安順利度過急性期，轉出重症加護中心，並復原回到家庭社會崗位上，個案照護之經驗將可提供臨床護理人員在照護此類個案時之參考。

關鍵字

不使用體外循環之冠狀動脈繞道手術；護理；心包膜填塞；跳動式冠狀動脈繞道手術

並列摘要

This is a paper to discuss a case of acute MI. His complaints were chest distress, shortness of breathing. After admission, we performed the cardiac catheterization which indicated that he had CAD with 90% occlusion in LAD, RCA and LMCA. We decided to perform off pumping coronary bypass surgery. After surgery, he was transferred to ICU nursing care during 2007.05.12-2003.05.16. In the view of physical assessment, observation and consultation with the patient, we collected the data and found nursing problems, such as symptoms related to decrease cardiac output, anxiety of patient, nutrition support and high risk of infection. By comprehensive nursing care, including checking of wound to prevent infection, monitoring vital signs, releasing wound pain, providing preoperative consultation about the knowledge of off-pumping coronary bypass surgery to decrease patient anxiety, and post operation ICU caring, we helped the patient and families to face the challenge, then he came over the critical period and went back to his duty. It is a so special nursing experience, that we expect this article to helpful for nursing this kind of patients.

並列關鍵字

Off pump Coronary Bypass ； Nursing ； Cardiac Tamponade ； Beating heart CABG

國際替代計量

一位接受跳動式冠狀動脈繞道手術病患之護理經驗

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