照護一位腦下垂體腫瘤術後出血病人之護理經驗

Nursing Experience of Caring for a Patient With Hemorrhage After Pituitary Gland Tumor Resection

10.6142/VGHN.202112_38(4).0008

王菁瑜(Ching-Yu Wang)；方韻芝(Yun-Jhih Fong)；金聖芳(Sheng-Fang Ching)；洪曉佩(Shiao-Pei Hong)；明金蓮(Jin-Lain Ming)

腦下垂體腫瘤 ； 出血 ； 尿崩症 ； pituitary gland tumor ； hemorrhage ； diabetes insipidus

榮總護理

38卷4期（2021 / 12 / 01）

399 - 405

繁體中文

腦下垂體腫瘤手術後常見合併症中，約有20%出現尿崩症情形，本文是照顧一位經鼻腔腦下垂體腫瘤切除手術病人，術後恢復期間發生尿崩症及出血不止，再度入手術室處理出血情形之護理過程，筆者照護期間2020年1月20日至1月21日，運用羅氏適應模式評估與收集病人資料並確立其健康問題為高危險性傷害、體液容積缺失及焦慮。照護期間針對病人的出血問題，穩定其生命徵象及血液動力學，並提供彈性會客時間，在家屬陪伴下，與病人詳細解說二度手術必要性及手術後照護要點，取得其信任與配合，順利渡過手術全期。由於病人術後僅短暫停留六個小時即轉出恢復室，如何讓病人在恢復室停留的有限時間內，逐步解除生理不適，及完善的心理支持，實為照護者之一大挑戰。

This article describes the experience of nursing a patient who underwent pituitary gland tumor resection and had postoperative diabetes insipidus and bleeding in the recovery room. The patient returned to the operating theater to confirm and manage the bleeding. To provide effective nursing care on January 20 and 21, 2020, the author used Roy's adaptation model as the conceptual framework for care, assessing and collecting patient data and identifying the patient's health problems: high-risk injury, loss of body fluid, and anxiety. The patient care included assisting in stabilizing the vital signs and hemodynamics, providing flexible visiting times for the family, explaining the need for the second surgery and the key points of postoperative care in detail to the family to gain trust and cooperation, and ensuring the smooth management of the postoperative period. Because the patient stayed in the hospital for only 6 hours after the operation, key challenges were relieving their physical discomfort and providing psychological support during the limited time in the recovery room. This patient care experience is shared as a reference for similar cases in the future.

1. 洪曉佩,曾麗華,雍允雯,林素萍,黃瓊慧,明金蓮(2019)。術前焦慮概念分析。榮總護理，36(2)，212-219。
   連結：
2. 張翠芬,趙正敏(2018)。身體自我概念對於社會體型焦慮之影響。領導護理，19(1)，22-39。
   連結：
3. 鄭玉欣,劉安祥,劉怡,陳幸眉(2016)。腫瘤手術前病人的主照顧者之照護需求及相關因素之探討。護理雜誌，63(3)，31-41。
   連結：
4. 醫學教育網 (2016，12 月 10 日 )．手術後出血的防治措施有哪些．https://read01.com/zh-tw/jQjaLD.html#.XmIbS1QzaW8
5. Lee, C. Y.,Chen, Y. C.,Wang, Y. P.,Chen, S. J.(2019).Difference in the incidence of cerebrospinal fluid leakage and residual tumors between functional and nonfunctional pituitary adenomas treated by endoscopic transsphenoidal pituitary adenomectomy.Journal of International Medical Research,47(11),5660-5670.
6. Menéndez, R.H.,Thompson, P.,Barea, H.,Lisdero, A. P.,Lew, J.,Elvira, J.,Lehrener, P. E.,Sole, H. A.(2020).Sphenoid sinus inverted papilloma: The challenge of operating sinonasal and skull base pathologies through a single-stage endoscopic endonasal approach.World Neurosurgery,133,260-265.
7. Sanchez, M. M.,Karekezi, C.,Almeida, J. P.,Kalyvas, A.,Castro, V.,Velasquez, C.,Gentili, F.(2019).Management of giant pituitary adenomas role and outcome of the endoscopic endonasal surgical approach.Neurosurg Clinics of North America,30(4),433-444.
8. 方科智,賴俊良,陳俞叡,朱逸羣,范國聖(2016)。晚期肺癌因腦下腺轉移引發的尿崩症，隨後發生上腸繫膜動脈症候群－病例報告。胸腔科學，31(4)，250-255。
9. 呂宜漩,余春娣,劉秀雲(2018)。運用羅氏適應護理模式於一位創傷性胸椎損傷病人之護理經驗。台大護理雜誌，14(2)，84-97。
10. 周同威,李國森,林鴻清,蔡循典,呂宜興,李振川,王瀛標(2015)。鼻竇內視鏡手術出血量相關因子的分析及探討。台灣耳鼻喉頭頸外科雜誌，50(2)，99-104。
11. 陳威宇,陳建宇(2017)。乳癌病人因轉移至腦垂腺所導致尿崩症之病人報告。內科學誌，28(4)，252-257。
12. 陳建民,陳瑩潔(2018)。內視鏡手術可治療腦下垂體腫瘤。彰基院訊，35(6)，8-9。
13. 劉雪娥（校閱）(2016).成人內科護理.華杏.