照顧一位到院前心跳停止肥厚性心肌症病人之急診護理經驗

An Emergency Nursing Experience of a Patient with Hypertrophic Cardiomyopathy Who Experienced Out-of-Hospital Cardiac Arrest

謝提諾(Tino Hsieh) ； 楊蓓菁(Bey-Jing Yang) ； 林乃華(Nai-Hua Lin)

《臺大護理雜誌》 16卷1期 (2020/01) Pp. 51-62

https://doi.org/10.6740/NTUHJN.202001_16(1).0006

摘要

肥厚性心肌症是因心肌異常增厚而造成心臟功能不全，具有高心因性猝死之風險，該疾病雖罕見但仍是造成許多青壯年病人意外死亡的原因。而本文描述一位到院前心跳停止，經急救後復甦之肥厚性心肌病39歲男性病人的急診護理經驗。藉由直接照護等方式進行資料收集，並以羅氏適應模式為評估指引，發現個案除了有心輸出量減少、潛在性腦組織傷害的健康問題外，還面臨因轉瞬之間的疾病變化帶來的死亡焦慮。在命懸一線的時間交迫下，護理過程中除了提供復甦後照護來穩定個案生命徵象，緩解其生理機能的傷害外，更陪伴個案處理其死而復生後，縈繞腦海的情緒轉折，更協助其與醫療團隊溝通，有限時間內整合醫療決策所需資訊，提升其對自身疾病的認知，減輕其對死亡的焦慮感，並且順利接受心導管處置，更進而重整自己正向地面對自身疾病所帶來的生命挑戰。建議單位在職教育增加復甦後心肌病照護及面對生死之相關訓練課程，並延續急診與緊急醫療服務系統之合作，設立後續追蹤系統，了解及協助個案返家自我照護情形，與身體、心理、社會、靈性層面的健康需求，達到持續性照護，也盼此經驗分享，有助臨床照顧此類病人之參考。

關鍵字

肥厚性心肌症 ； 到院前死亡 ； 復甦後照護

並列摘要

Hypertrophic cardiomyopathy is a form of cardiac insufficiency caused by abnormal thickening of the heart muscle and carries a high risk of sudden cardiac death. Although rare, this disease is a prominent cause of accidental death in young adults. This article describes the emergency care experience for a 39-year-old man with hypertrophic cardiomyopathy with a stopped heartbeat before reaching the hospital. On March 13, 2018, the author collected data by direct care, using the Roy's Adaptation Model as an assessment guide. In addition to the health problems of reduced cardiac output and potential brain tissue damage, the patient also experienced with transient death anxiety. In the context of a near death experience, in addition to providing post-recovery care to stabilize vital signs and improve physiology of the injury, the care also focused on dealing with death and resurrection, which improved the patient's mood and served as a model case. The spokesperson and consultants helped communicate with the medical team, integrate the information needed for medical decision-making within a limited time, enhanced awareness of their own diseases, reduced anxiety about death, and facilitated smooth acceptance of cardiac catheterization. In turn, this approach served to reorganize life priorities in the face of disease. Finally, it is recommended to increase resuscitation training in the unit's in-service education through courses on cardiomyopathy and life-and-death, continue the cooperation between emergency departments and the emergency medical service system, and establish a follow-up tracking system to understand and assist cases returning home to self-care for the body. Health care must be provided at the psychological, social, and spiritual levels in order to achieve continuous care. We hope to share this experience in an effort to enhance the clinical care for such patients.

並列關鍵字

hypertrophic cardiomyopathy ； out-of-hospital cardiac arrest ； post-recovery care