黑夜盼見黎明－「抗磷脂症候群」婦女反覆流產後成功生產之心路歷程

研究背景：抗磷脂症候群（APS）婦女直到多次流產查不出原因後才會到免疫科檢查，經治療後胎兒存活率可從10%提升至70-80%。綜觀中西方醫學文獻均致力APS病理治療研究，或著重孕期失敗照護，未見從APS婦女成功生產的經驗歷程探討她們身心照護之需求。研究目的：探究抗磷脂症候群婦女成功生產的經驗，以作為臨床醫護人員提供早期治療、成功生產及合宜健康照護之依據。研究方法：採質性研究設計，於南部某醫學中心立意取樣6位年齡介於33-40歲之初產APS婦女，以內容分析法進行訪談資料分析。研究結果：歸納抗磷脂症候群婦女歷經反覆流產後成功生產的五大階段經驗為 (一)反覆流產盼為母：1.流產的悲傷與自責2.再次懷孕的憂喜交集3.輿論與污名標籤(二)自力救濟尋真相：1.對醫療專業的懷疑2.主動搜尋相關資訊(三)自助人助拼成功：1.找到原因生希望2.跨專科共同診治(四)多方支持度不安：1.懷孕過程的忐忑不安2.家人病友與醫護支持(五)懷抱麟兒獲尊嚴：1.得償宿願的喜悅2.完整女性的驕傲。結論：抗磷脂症候群婦女常為生育承受身心之苦，因此護理人員須提高對抗磷脂症候群婦女身心症狀與健康需求的察覺度與敏銳度，才能整合照護訊息，提供婦產科醫師相關評估資料，以便能儘早轉介免疫專科檢查，達成跨專科的共同合作，給予合宜的照護。關鍵字：反覆流產、抗磷脂症候群、跨科合作、醫療自主

關鍵字

反覆流產；抗磷脂症候群；跨科合作；醫療自主

並列摘要

Background: Women with antiphospholipid syndrome (APS) usually take immunology examination after experienced unreasonable miscarriages. However, the fetus survival rate could be improved from 10% to 70-80% after treatment. Both Eastern and Western medicine researchers devote on doing researches related to APS pathology, treatment and/or miscarriage care. Literature about to explore the physical and mental nursing needs of successful production women with APS is scant. Purpose: The aim of this study is to explore successful production experience of women with APS to support appropriate health care, early treatment and successful producing. Methodology: A qualitative study design was used. Purposive sampling was conducted, six women with APS between the ages of 33-40 years old, at the beginning of production, were recruited in a medical center in southern. Content analysis was used to analyze the qualitative interview data. Result: The successfully produced experience of five stages of women with APS experience miscarriage repeatedly are 1. Hope to be a mother: (1) Sadness and self-blame of miscarriage (2)Have mixed feelings about re-pregnancy (3)Public opinion and stigma label 2.Help herself to find truth：(1)Doubting about medical profession (2)Searching relevant information actively 3.God helps those who help themselves：(1)To have hope base on the truth (2)Interdisciplinary treatment 4.supportive environment for uneasy：(1)Uneasy during pregnancy (2)Supportive families and medical team network 5.The dignity base on fertility：(1) Joy of wish fulfilled (2)The proud of be a completed woman. Conclusion: Women with APS are suffering. Thus nurses should be aware of patient’s sign, symptom and real concern, and integrate information of assessment to doctors for taking immunology examination referral. Interdisciplinary cooperation may be necessary for appropriate caring. Keywords: recurrent miscarriage, antiphospholipid syndrome, interdisciplinary cooperation, medical autonomy