周產期窒息新生兒接受全身性低溫療法之照護經驗

A Nursing Care Experience of Applying Whole-Body Hypothermia for Perinatal Asphyxia Neonate

陳采邑(Cai-Yi Chen) ； 范圭玲(Guei-Ling Fann) ； 陳玉蓮(Yu-Lien Chen)

《臺大護理雜誌》 16卷1期 (2020/01) Pp. 27-38

https://doi.org/10.6740/NTUHJN.202001_16(1).0004

摘要

本文描述照護一位周產期窒息新生兒接受全身性低溫療法之照護經驗，護理期間為2017年5月3日至5月12日，個案於某診所出生後發生窒息缺氧情形，故轉診至本院加護病房，經醫療團隊評估後，執行低溫治療以降低因周產期窒息缺氧發生相關合併症及死亡率，藉由系統性身體評估、直接臨床照護及與家屬會談的方式，進行主客觀資料的收集，確立其健康問題為：氣體交換障礙、潛在危險性皮膚完整性受損、腦組織灌流失效及照顧者角色緊張，針對全身性低溫療法所產生之併發症擬定具個別性之護理計畫，給予相關護理措施，以提升整體的照護品質，並提供以家庭為中心的護理模式，鼓勵案父母積極參與個案之照護技能活動，以降低案父母內心的徬徨及罪惡感，增進親子依附關係。因本病房初次採行全身性低溫療法，希望藉此個案照護經驗之整理及分享，提供臨床醫療人員對於新生兒執行全身性低溫療法之認識，並作為日後照護此類個案之參考。

關鍵字

全身性低溫療法 ； 周產期窒息 ； 新生兒缺氧缺血性腦病變

並列摘要

This article describes a nursing care experience of whole-body hypothermia with perinatal asphyxia in a neonate that resulted in hypoxic-ischemic encephalopathy. The care period ran from May 3^(th) to May 12^(th), 2017, and the case was transferred to our hospital from the local clinic after birth due to asphyxia. After an assessment by our medical team, we used whole-body hypothermia to reduce the complications and mortality caused by perinatal asphyxia. Data were collected by systematic physical examination, practical clinical care, and interviews, which revealed four major problems: (1) impaired gas exchange; (2) ineffective brain tissue perfusion; (3) risk of impaired skin integrity; (4) caregiver role strain. Such events can have substantial impacts on the family; in order to reduce their anxiety and increase the nursing care quality, we used the family-centered model to encourage the parents to join activities of the infant's daily care, which serve to decrease the parents' uncertainty and guilt and also promote parent-child attachment. This was the first use of whole-body hypothermia in our ward; sharing of the care experience provided the clinical staff with an enhanced understanding of the implementation of whole-body hypothermia in neonates and will serve as a reference for such cases in the future.

並列關鍵字

whole-body hypothermia ； perinatal asphyxia ； hypoxic-ischemic encephalopathy