海洛因成癮患者手術的麻醉照護－案例報告

Anesthetic Care of Patient With Heroin Addiction: A Case Report

10.6224/JN.201804_65(2).13

李文怡(Wen-Yi Lee)；郭淑瑜(Shu-Yu Kuo)

毒癮 ； 海洛因 ； 麻醉照護 ； 案例報告 ； drug addiction ； heroin ； anesthetic care ； case report

護理雜誌

65卷2期（2018 / 04 / 01）

100 - 108

繁體中文

台灣社會使用非法毒品人口日趨攀升，而藥物成癮者通常伴隨複雜的生理、心理與社會問題，且經常以欺騙、隱瞞或低報來迴避自身非法用藥問題，如何和毒癮患者建立專業信任關係，以確保專業照護品質，乃是重要的臨床課題。本文敘述一位海洛因成癮者因車禍，需接受股骨和髕骨兩處開放復位固定手術的麻醉照護過程，照護期間於2015年11月30日23:00至12月1日5:00，於手術室期間為六小時。病患於手術前欺騙其毒癮狀態，但麻醉護理師使用敏銳的觀察力發現細微徵象，並運用同理心及創造安全的溝通環境，成功使病人坦承毒癮用藥狀況，並進行醫護策略的適時溝通及調整，最後順利避免血液傳染的致病感染、潛在戒斷症狀發生及高度疼痛敏感。台灣針對海洛因成癮病患的溝通及麻醉照護經驗相關文獻較少，因此將此護理經驗分享，期盼有更多毒癮照護的案例及研究的發表，提供臨床更多建議與改善方針，以創造更優質的照護品質。

The use of illegal drugs in Taiwan is on the rise. Drug addicts often have complex physical, psychological, and social problems. In addition, they often avoid disclosing their illicit drug use by deceit, concealment, or under-reporting. Building and maintaining relationships of trust with drug-addict patients has become a critical issue in achieving better care quality. In this case report, we report on an anesthesia care process for a heroin addict who was admitted for open reduction and internal fixation surgery for the femur and patella fractures after a car accident. During the six-hour perioperative care period, starting from 11pm on November 30th to 5am on December 1st, 2015, the patient was not willing to disclose his illicit drug use before the surgery. However, the nurse anesthetist noticed signs and symptoms of drug use. The nurse empathized with the patient's worries, provided him with a safe communication environment, and gained trust from the patient in a timely manner, which then enabled the patient to fully disclose his illicit drug use with the nurse anesthetist. The anesthesia-care strategy was then modified according to client's condition. The nurse anesthetist played an important role of bridging communications between the patient and medical care staffs and of modifying the care strategies in a timely manner. During the care period, the blood-borne disease contamination was successfully prevented, the client received uneventful pain management, there was a lack of withdrawal symptoms, and the staffs and patient safety was maintained. The literature on the anesthetic care of heroin patients undergoing surgery is relatively limited in Taiwan. The findings in the current case report add information on providing anesthetic care to patients with drug addiction. Publishing additional case reports, research, and clinical recommendations is essential for improving care quality for this vulnerable population.

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