目標溫控治療－兒科重症病童臨床照護實務

目標溫控治療是利用低溫來延緩腦部代謝速率、抑制炎症反應、降低細胞毒素釋放以達到保護腦部神經元的作用，並減少腦損傷所產生的合併症。目標溫控治療廣泛運用於成人醫療中，在兒科則常用於缺血性腦病變新生兒、心跳停止後、創傷性腦外傷及癲癇重積症病童。在執行目標溫控治療的過程中，需具備敏銳的觀察力、豐富專業的知識及技術，以預防低溫過程中所帶來的相關合併症如肺水腫、電解質異常、凝血功能異常、心律不整、血糖、血壓的不穩定、感染等。需注意每小時或依醫囑監測體溫、定時追蹤血液檢驗、密切監控心電圖變化，觀察有無心律不整或電解質異常發生、預防感染發生、每2小時協助翻身及抬高床頭30度。本文藉由分享照護經驗，希望提供照護時的參考。

關鍵字

目標溫控治療；兒科重症；臨床照護

並列摘要

Targeted temperature management is using low temperatures to delay brain metabolism, inhibit the inflammatory response, and decline cytotoxic release to protect brain neurons and reduce complications caused by brain injury. Targeted temperature management is widely used in adults, and in pediatrics, it is commonly used in neonates with hypoxic ischemic encephalopathy, cardiac arrest, traumatic brain injury, and children with status epileptics. In the process of implementing target temperature management, nurses need to have keen observation, rich professional knowledge, and technology to prevent related complications such as pulmonary edema, electrolyte abnormality, coagulation disorder, arrhythmia, unstable blood sugar and blood pressure, infection, etc. Nursing care should pay attention to monitoring body temperature every hour or according to doctor's orders, regularly tracking blood tests, closely monitoring Electrocardiography, observing whether there is arrhythmia or electrolyte abnormality, preventing infection, assisting turning over every 2 hours and raising the head of the bed 30 degrees. These nursing experiences are provided for nursing care to reference.

並列關鍵字

targeted temperature management ； pediatrics critical care ； nursing care

參考文獻

賴靜怡、蕭慧玲 (2020)．低溫治療知識發展里程碑．彰化護理，27(4)，2-14。https://doi.org/10.6647/CN.202012_27(4).0002

吳大偉、楊志仁、黃玉雰、蔡忠榮、黃吉志、黃明賢、許超群 (2013)．心跳停止經急救復甦後的低溫治療．內科學誌，24 (6)，433-445。https://doi.org/10.6314/JIMT.2013.24(6).0

Hsu, M. H., Kuo, H. C., Lin, J. J., Chou, M. Y., Lin, Y. J., & Hung, P. L. (2020). Therapeutic hypothermia for pediatric refractory status epilepticus May Ameliorate post-status epilepticus epilepsy. Biomed J. 43(3), 277-284. https://doi.org/10.1016/j.bj.2020.04.004

Marlow, N., Shankaran, S., Rogers, E. E., Maitre, N. L., Smyser, C. D. (2021). Newborn Brain Society Guidelines and Publications Committee. Neurological and developmental outcomes following neonatal encephalopathy treated with therapeutic hypothermia. Semin Fetal Neonatal Med, 26(5), 101274. https://doi.org/10.1016/j.siny.2021.101274

Scholefield, B., Duncan, H., Davies, P., Gao, Smith. F, Khan, K., Perkins, G. D., Morris, K. (2013). Hypothermia for neuroprotection in children after cardiopulmonary arrest. Cochrane Database of Systematic Reviews. 2. https://doi.org/10.1002/14651858.CD009442.pub2

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