照顧一位流感併發重症使用葉克膜體外維生系統病人之護理經驗

本文探討一位流感併發重症引起急性呼吸窘迫症候群、敗血性休克病人，緊急放置葉克膜體外維生系統給予心肺支持，經過醫療團隊共同照護，順利轉出加護病房之護理經驗。照護期間自2016年2月20日至3月6日，筆者透過觀察、身體評估、會談等技巧收集資料，並運用Gordon十一項健康功能型態進行評估，確認健康問題有：氣體交換功能障礙、潛在危險性損傷、身體活動功能障礙、焦慮。照護過程中密切監測生命徵象、胸部X光及動脈血液氣體分析，成功脫離葉克膜體外維生系統；追蹤血液動力學變化，改善休克，觀察侵入性管路未發生出血或感染；早期介入復健治療，使四肢肌肉力量逐漸改善；面對病人焦慮不安，照護期間以同理心傾聽感受與需求，陪伴並給予心理支持，提供疾病相關訊息，彈性會客，緩解病人焦慮，增進信心。治療指引指出施打疫苗是預防流感最有效的方法，筆者臨床觀察多位流感併發重症病人為青壯年族群均未施打疫苗，亦非公費施打對象，故建議補助未納入公費者、增加接種便利性，並透過新聞或海報等方式推廣重要性等疫苗接種率提升措施。

關鍵字

流感併發重症；葉克膜體外維生系統

並列摘要

This case report explored the nursing experience of extracorporeal membrane oxygenation used in complicated influenza patients in intensive care units, then to be successful weaning. Case was provided from February 20 to March 6, 2016. Gordon's 11 Functional Health Patterns were utilized as evaluation guides. Data were collected through direct cure, observation, listening, caring, and physical examination as well as from medical records. The patient was observed including for impaired gas exchange, risk of potential severe injury, impaired physical mobility, and anxiety. Vital signs were closely observed, along with ventilation and oxygenation for timely and successful Extracorporeal Membrane Oxygenation weaning. Hemodynamic status was monitored for early detection of potential shock, catheter-associated bleeding, or infection. Early rehabilitation team engagement was applied to alleviate and even prevent muscular atrophy. We furthermore used psychosocial support to reduce the patient's anxiety, emphasize his emotional needs, build rapport with psychological support, and empower the patient and his family with extensive clinical information and flexible visiting hours. Treatment guidelines specify that vaccination is the most effective method to prevent influenza, but many young and middle-aged flu patients are not vaccinated, and vaccination is not covered by our national health insurance. Therefore, we recommend escalating vaccination coverage by national health insurance, improving vaccination accessibility, and using advertisement or free publicity to increase vaccination rates.

並列關鍵字

severe complicated influenza ； extracorporeal membrane oxygenation

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