達文西機器手臂於心臟微創手術的應用與護理

Application and Nursing Care of da Vinci Robotic-Assisted Minimal Invasive Surgery in Cardiac Diseases

范雅芬(Ya-Fen Fan) ； 蘇淑芬(Shu-Fen Su) ； 李君儀(Jiun-Yi Li) ； 吳晶萍(Ching-Ping Wu) ； 蔡榮美(Jung-Mei Tsai)

《馬偕護理雜誌》 8卷2期 (2014/07) Pp. 7-15

https://doi.org/10.29415/JMKN.201407_8(2).0001

摘要

傳統的心臟手術是將胸骨正中切開，病人傷口須經三到六個月的時間來癒合，輔以心肺復健，才可恢復正常生活。爾後雖有傷口較小的心臟微創手術被開發，但有時會因視野及器械靈活度受限，無法精確縫合，而改回傳統開刀手術。近期所發展的達文西機器人輔助微創手術，可透過高解析3D立體影像，機械手臂的仿真手腕設計，能在狹小空間內進行精細心臟手術動作。經由實證研究得知，此新興手術由於傷口小而美觀、恢復時間快、住院期短、術後疼痛減少、病人滿意度提高等優點，可提供沒有複雜嚴重病史的心臟病患者，手術治療時的優先選擇。但也容易出現心律不整、血液動力學不穩、呼吸衰竭、腦中風等合併症，所以術後的護理是非常重要的問題。文獻查證發現目前達文西手術研究多以醫療處置或預後為主，並無護理照護相關的研究，因此建議深入護理研究之必要性，以期能提供護理人員在照護此類病人時的實證參考和依據。

關鍵字

達文西機器手臂 ； 輔助微創手術 ； 心臟手術 ； 護理

並列摘要

The da Vinci surgical system is a state-of-the-art robotic surgical platform with 3D, high-definition vision and miniaturized, wristed instruments designed to help doctors take surgery beyond the limits of the human hands. Doctors control the da Vinci system that translates their hand movements into more precise motion of miniaturized instruments inside patients' body. With US FDA clearance, the da Vinci surgical system is changing the face of cardiac surgery. Compared to traditional open surgery, patients are becoming more acceptance of a less invasive approach as they experience reduced postoperative pain, shorter hospital stay, faster recovery and return to normal daily activities, as well as improved cosmesis. Minimally invasive da Vinci surgery will provide a large value in management of patients with heart disease. This article discusses the development of da Vinci cardiac surgery, indications, operative procedures, outcomes, prognostic factors, complications and clinical problems encountered during nursing care. It is necessary for clinical nurses to aware of the progress. And the nurses should educate the patients for early detection of problems.

並列關鍵字

da Vinci surgical system ； robotic assisted minimally invasive surgery ； cardiac surgery ； nursing care