發炎性肌纖維母細胞瘤壓迫阻塞呼吸道置入支架之呼吸照護

Respiratory Care of Airway Stent Insertion for Airway Obstruction by Inflammatory Myofibroblastic Tumor

陳玥螢(Yueh-Yin Chen) ； 林鳳卿(Feng-Ching Lin) ； 許諄諄(Chun-Chun Hsu) ； 吳惠東(Huey-Dong Wu)

《呼吸治療》 18卷1期 (2019/07) Pp. 51-60

https://doi.org/10.6269/JRT.201907_18(1).0005

摘要

呼吸道支架是一種放置在呼吸道內的管狀裝置，可快速緩解呼吸道阻塞導致呼吸困難症狀並且為治療爭取更多時間。其適應症可分為良性或惡性的導因，由於呼吸道支架對於呼吸道而言可視為外來物，因此可能引發呼吸道發炎反應、氣管支架滑動、痰液分泌增加及排除困難、肉芽組織的增生、慢性感染、呼吸道壁破裂、咳血等的合併症，仔細的評估及良好的支架尺寸選擇對減少合併症來說是非常重要的。本個案為患有發炎性肌纖維母細胞瘤的患者，由於腫瘤轉移至肺部，壓迫左主支氣管導致呼吸道阻塞呼吸困難高碳酸血症等，因此放置呼吸道支架以及切除腫瘤以維持氣道暢通為本病人首要治療。支架放置後的呼吸照護介入當務之急為吸道痰液的清除及評估，避免痰液堆積造成氣體交換障礙危及病人生命安全。此腫瘤進展快速，呼吸道支架的放置不僅緩解了因腫瘤壓迫導致的呼吸道阻塞，改善呼吸困難症狀並延長病人生命，亦可爭取治療時間，帶給病人更好的生活品質。

關鍵字

發炎性肌纖維母細胞瘤（inflammatory myofibroblastic tumor） ； 呼吸困難（dyspnea） ； 呼吸道置入支架（airway stent insertion）

並列摘要

Airway stents are tubular device placed in respiratory tracts that can quickly relieve dyspnea caused by airway obstruction and then gains more time for treatment. The indications of airway stents include benign or malignant causes. Since the airway stents can be regarded as a foreign object to the respiratory tracts, it may cause airway inflammatory reactions, tracheal stent sliding, sputum hypersecretion, granulation tissue hyperplasia, chronic infections, rupture of the respiratory tracts, hemoptysis, etc. Therefore, careful evaluation and selecting a suitable stent size are very important to reduce comorbidities. This case is a patient with inflammatory myofibroblastic tumor. Because the tumor metastasizes to the lungs, compressing the left main bronchus leads to airway obstruction, dyspnea, hypercapnia, etc. Therefore, placing the airway stent and removing the tumor to maintain a patent airway are the first issue for the patient. A top priority of respiratory care after stent placement is to remove the sputum and then evaluate the condition, avoiding gas exchange barriers caused by sputum accumulation and endangering patient's life. Since the tumor progresses very quickly, the placement of the airway stent not only alleviates the airway obstruction caused by tumor compression, improves the symptoms of dyspnea and prolongs the life of the patient, but also gets more time for medical treatments and brings better life quality for the patient.

並列關鍵字

inflammatory myofibroblastic tumor ； dyspnea ； airway stent insertion