照護一位28歲馬凡氏症候群合併主動脈剝離術後病人之護理經驗

馬凡氏症候群是一種影響結締組織的自體顯性遺傳疾病，病人會有心血管系統異常情形，進而引發主動脈剝離。主動脈剝離是心血管急症，若未及時診斷並治療，在症狀開始每隔一小時死亡率增加1-2%，本文於探討一位28歲初次住院發現患有馬凡症候群，因急性胸痛於急診室追蹤胸部電腦斷層診斷Type A主動脈剝離，並緊急施行進行主動脈根部機械瓣帶瓣管道置換術（Bentalls）手術，於加護病房觀察後轉至普通病房，病房照護期間2018年07月23日至08月5日，藉由觀察、會談及查閱病歷等方式收集資料，並經Gordon十一項護理評估後，急性疼痛、呼吸道清除功能失效、焦慮護理問題，並擬定照護計畫，藉由陪伴、傾聽與多次討論及示範等衛教方式，與個案建立治療性人際關係，並協助個案對於緩解疼痛、術後控制血壓、傷口照護及日常生活適應以建立正確觀念，希望藉此個案之疾病診斷及護理過程，提供照護參考。

關鍵字

馬凡症候群；主動脈剝離術後；護理經驗

並列摘要

Marfan syndrome is an autologously genetic disease that affects connective tissue. The patient will experience abnormalities in the cardiovascular system, which can lead to aortic dissection. Aortic dissection is a cardiovascular emergency. If it is not diagnosed and treated in time, the mortality rate increases by 1-2% every hour at the beginning of the symptoms. This article discusses a 28-year-old hospitalized for the first time with Marfan syndrome and was in the emergency department due to acute chest pain Department tracking chest computerized tomography diagnosed Type A aortic dissection, and urgently performed aortic root mechanical valve and valve tube replacement (Bentalls) operation, and was transferred to the general ward after observation in the intensive care unit. The ward care period from July 23 to August 5th in 2018, collect data through observation, interviews and access to medical records, and after Gordon's eleven nursing assessments, care problems such as acute pain, respiratory tract clearance failure, anxiety, have been drawn up and a care plan has been drawn up by accompanying , Listening, discussion and demonstration, establish therapeutic interpersonal relationship with the case, and assist the case to establish correct concepts for pain relief, postoperative blood pressure control, wound care and daily adaptation. Hope to take advantage of the case's illness Provide care reference for diagnosis and nursing process.

並列關鍵字

Marfan Syndrome ； aortic dissection ； Nursing experience

參考文獻

Goyal A, Keramati AR, Czarny MJ, Resar JR, Mani A: The Genetics of Aortopathies in Clinical Cardiology. Clinical Medicine Insights: Cardiology 2017; 11: 1-11.