一位心跳停止後復甦病患使用目標溫控治療之照護經驗

Nursing Care Experiences of the Patient with Cardiac Arrest Using Targeted Temperature Management

鄭庭恩(Ting-En Jheng) ； 林汭蓁(Ruei-Jhen Lin)

《健康照護科學雜誌》 5期 (2023/12) Pp. 41-50

摘要

本文個案發生心跳停止後，經歷心肺復甦術後恢復自發性循環，入住加護病房後使用目標溫控治療（Targeted Temperature Management, TTM）之照護經驗，照護期間2020年9月4日至9月11日，藉由直接照護、筆談、查閱病歷、實際身體評估收集病史及相關資料，再以Gordon十一項功能性健康形態評估方式確立個案有心輸出量減少、潛在危險性損傷、焦慮三項健康護理問題。護理過程，筆者優先穩定個案血液動力學及提供適當的處置增加心輸出量；儘早執行TTM保護腦部神經，預防TTM相關併發症發生及評估神經學恢復狀況；藉由直接照護發現個案焦慮問題，以跨團隊醫療照護模式，提供具個別性護理措施及提供專業衛教指導，提升返家自我照護信心。筆者藉由此次照護經驗，建議使用TTM應在復甦後盡早使用，把握病患黃金治療時間。

關鍵字

心跳停止 ； 目標溫控治療 ； 焦慮

並列摘要

In this case, after cardiac arrest, the spontaneous circulation of the patient was restored after cardiopulmonary resuscitation, and targeted temperature management (TTM) was used after the patient was admitted to an intensive care unit. During the nursing period from September 4 to September 11, 2020, the medical history and related data were collected through direct nursing care, written conversations, review of medical records, and actual physical assessment. Additionally, three healthcare issues including reduced cardiac output, potentially dangerous injury, and anxiety were identified by Gordon's 11 functional health patterns assessment. In the nursing process, the author prioritized the stabilization of the patient's hemodynamics and provided appropriate treatment to increase cardiac output. Besides, the author performed TTM timely to protect brain nerves, prevented TTM-related complications, and assessed neurological recovery. Through direct nursing care, the author identified anxiety issues and provided individualized care and professional health education through a cross-team healthcare model to enhance the patient's confidence in self-care at home. Through this nursing experience, the author suggested that TTM should be adopted as early as possible after resuscitation to grasp the golden period of treatment.

並列關鍵字

cardiac arrest ； targeted temperature management ； anxiety