協助一位顱內出血術後病患呼吸器脫離之護理經驗

Nursing Experience of Assisting the Transition of the Post-Craniotomy Patient from Mechanical Ventilation to Spontaneous Ventilation

盧威如(Wei-Ju Lu) ； 李愛誠(Ai-Cheng Li)

《中山醫學雜誌》 23卷1期 (2012/03) Pp. 55-65

https://doi.org/10.30096/CSMJ.201203.0007

摘要

顱內出血可藉由外科手術來治療並降低顱內壓進而增加腦灌流量，病患在開顱術後亦常因手術時間長且吸入高濃度氧氣、術後鎮靜劑使用及出血導致的功能障礙而依賴呼吸器。本文係探討一位顱內出血術後個案於神經外科加護病房照護之護理經驗，個案因顱內出血行開顱手術，術後氣管內管放置並使用呼吸器，護理期間為2009年2月28日至3月16日，以羅氏適應模式理論為架構，藉由觀察和會談方式及收集病歷資料，進行護理評估，確立個案護理問題有：顱內調適能力降低、照顧者角色緊張、低效性呼吸型態。經由監測和觀察顱內壓變化，執行適切護理措施，維持足夠腦灌流壓；主動關懷家屬及適時給予衛教，緩解照顧者緊張和建立自信心；另循序漸進訓練呼吸肌，使個案增加咳痰能力，成功脫離呼吸器，期藉此護理經驗亦提供本單位護理同仁在照護類似個案之參考。

關鍵字

顱內出血 ； 呼吸器脫離 ； 護理經驗

並列摘要

Intracerebral hemorrhage (lCH) can be treated with surgical intervention to reduce intracranial pressure (ICP) and increase cerebral perfusion. Patients undergoing craniotomy are often ventilator dependent due to brain lesions caused by the long operation period, inhalation of high-concentration oxygen, use of postoperative sedatives, and hemorrhage. This study focused on the experience of caring for an ICH postoperative patient in the intensive care unit of a neurosurgery department. The patient underwent a craniotomy procedure due to ICH. After operation, an endotracheal tube was inserted and the patient became ventilator dependent. The nursing period was from February 28 to March 16, 2009. The research framework was based on Roy's adaptation model. Using observation and interviews to collect medical records and performing nursing assessment, we found the nursing issues to be as follows: decreased intracranial adaptive capacity, caregiver role strain, and ineffective breathing pattern. Nursing staff should monitor changes in ICP and perform appropriate nursing interventions to maintain adequate cerebral perfusion pressure (CPP). They should also give health education to patient's, relatives to relieve caregiver strain and establish confidence. In addition, nursing staff should gradually train the patient's respiratory muscles to increase the patient's expectoration ability and enable weaning from the ventilator. We hope that this study can serve as a reference for nursing staff of this unit in provision of care for similar patients.

並列關鍵字

Intracerebral hemorrhage ； weaning ventilator ； nursing experience