一位因事故導致肺挫傷使用葉克膜治療病人之加護照護經驗

Intensive Care Experience of a Patient with Accidental Pulmonary Contusion Treated with ECMO

林娟妙(Jyuan-Miau Lin) ； 劉士榳(Shin-Ting Liu)

《臺大護理雜誌》 15卷2期 (2019/07) Pp. 60-71

https://doi.org/10.6740/NTUHJN.201907_15(2).0007

摘要

本文為描述一位22歲因事故傷害，導致嚴重肺挫傷併發急性呼吸窘迫症候群個案，使用體外膜氧合器治療之護理經驗。照護期間為2016年9月24日至10月11日，以觀察、會談、身體評估、直接照護及查閱病歷方式，進行生理、心理、社會及靈性四大層面的資料收集，確立個案有氣體交換障礙、潛在危險性感染、潛在危險性創傷後壓力症之健康問題，在體外膜氧合器治療下，維持生命徵象的穩定，改善肺部損傷及氣體交換障礙問題，成功脫離呼吸器，並運用組合式照護措施以控制感染的發生，針對個案創傷後的心理問題，以肌肉放鬆、腹式呼吸、念頭中斷、正向思考、自信心的建立、適時陪伴傾聽、提供環境的安全及隱私性等之護理措施，協助個案走出創傷後所造成的心理陰影。建議針對創傷病人，宜儘早評估有無創傷後壓力症狀，及早照會臨床心理師並列入常規，以協助病人走出創傷後陰影並回復心理健康，亦藉此次照護經驗提供臨床參考。

關鍵字

肺挫傷 ； 創傷後壓力症

並列摘要

This article described the nursing care of a 22-year-old accident victim with a severe pulmonary contusion and acute respiratory distress syndrome treated with extracorporeal membrane oxygenation (ECMO). The period of nursing care was from September 24 to October 11, 2016. Based on physical, psychological, social, and spiritual assessments, data were collected through observation, interview, physical examination, direct care, and medical chart review. Identified health problems included impaired gas exchange, risk for infection, and risk for posttraumatic stress disorder. The care included ECMO treatment for lung injury and impaired gas exchange, bundle care to prevent infection, muscle relaxation, abdominal breathing, interruption of thought, positive thinking, self-confidence, timely listening, environmental safety, and privacy care measures to help this patient recover from his psychological trauma. It is recommended that a trauma patient be assessed for posttraumatic stress symptoms as early as possible, and that a clinical psychologist is consulted as a routine measure to help patients recover from their horrible experience. This care experience should be used as a clinical reference.

並列關鍵字

respiratory distress ； posttraumatic stress