照護一位罹患先天性橫膈疝氣病童接受體外維生系統治療之護理經驗

Nursing Care Experiences of a Congenital Diaphragmatic Hernia Patient with Extracorporeal Membrane Oxygenation Support

黃士凡(Shih-Fan Huang) ； 温淑如(Shu-Ru Uen)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 134-145

https://doi.org/10.6740/NTUHJN.201901_15(1).0013

摘要

本文為照顧一位先天性橫膈膜疝氣之病童接受體外維生系統輔助治療及對家庭衝擊之護理經驗。於2016年5月27日至8月30日照護期間以臨床實際照護觀察、病歷資料收集，及與家屬會談進行評估。發現個案有危險性感染、氣體交換障礙、親職角色衝突等問題。個案在急性期使用體外維生系統（ECMO）治療20餘天後移除，但因為氣管軟化導致移除氣管內管失敗後行氣管切開術，過程中家屬常感到難過、失落等情緒，且需面臨重大醫療決策的抉擇，經由醫療團隊會談及協助，家屬漸漸能接受個案疾病變化，並能以樂觀的態度面對個案後續病程變化。藉由個別化護理措施，提供個案舒適、滿足其需求、維持肺部正常換氣功能及預防相關性肺炎發生等，並且針對案父母親職角色衝突，運用同理心、鼓勵表達內心感受、彈性調整會客時間，促進親子依附關係建立，讓其參與照護及學習相關照護技巧，發展其親子依附關係。此個案為臨床少見之案例，希望藉此次照護經驗，能提供護理人員照護此類病童之參考。

關鍵字

先天性橫膈膜疝氣 ； 體外維生系統 ； 氣管

並列摘要

This article described the nursing care of a congenital diaphragmatic hernia patient with extracorporeal membrane oxygenation (ECMO) support. The article also focused on discussing the impact of such a disease in a family. The clinical care process was recorded from 27^(th) May to 30^(th) August 2016 via practical care with observation, medical data collection, and discussion with the family. After comprehensive evaluation, infection risk, gas exchange impairment, and parental role conflict had been highlighted as primary nursing care issues. Due to the patients suffering from critical illness, ECMO was used for 20 days. The complication of the disease itself, such as tracheomalacia, and the treatments made weaning the ventilator difficult. As a result, tracheotomy was performed after the failure of extubation. The parents were frustrated during the in hospital period, especially when facing significantly medical decision-making. Because of the interview and assistance of the medical team, the family members could accept the patient's condition gradually and changed their attitude toward the disease. Person-centered care for the patient and family-centered care for parents were performed, in order to provide a more comfortable environment. Moreover, the nursing care plans were aiming to meet the patient's needs and maintain normal pulmonary ventilation. Parental role conflict was noted and managed through empathetic conversation. Visiting hours was altered to provide a more friendly clinical environment. We also invited family members to learn and participate in patient care, which could build up a stronger child-parental relationship. Finally, we would like to share this case experience in order to provide a congenital diaphragmatic hernia care model and fulfill the essence of nursing care.

並列關鍵字

congenital diaphragmatic hernia ； extracorporeal membrane oxygenation (ECMO) ； tracheomalacia