照護一位脊髓麻醉急救後復甦病人之護理經驗

Nursing Experience of Caring for a Patient with Emergency Resuscitation After Spinal Anesthesia

10.6142/VGHN.202206_39(2).0010

魏琬容(Wan-Jung Wei)；曾麗華(Li-Hua Tseng)；童湘茹(Hsiang-Lu Tung)；陳琪欣(Chi-Hsin Chen)；方韻芝(Yun-Jhih Fang)；洪曉佩(Shiao-Pei Hong)

全脊髓麻醉 ； 脫離呼吸器 ； 焦慮 ； total spinal anesthesia ； weaning ventilator ； anxiety

榮總護理

39卷2期（2022 / 06 / 01）

214 - 220

繁體中文

全脊髓麻醉發生非常罕見，儘管發生率極低，若無即時處理，恐造成致死憾事。本文描述一位75歲女性，採脊髓麻醉備行膝關節置換術，施打麻醉藥物後發生全脊髓麻醉，心電圖顯示無脈性電氣活動（pulseless electrical activity, PEA），進行心肺復甦術後，轉入恢復室。照護期間為2021年2月18日08:50至17:00，藉由直接護理、身體評估、全方位觀察、會談及查閱病歷等收集資料，採Gordon十一項功能性健康型態評估，確立健康問題有心輸出量不足、氣體交換障礙、焦慮。病人甦醒後，面對毫無心理準備的侵入性治療，感到恐懼、激動且不配合治療；護理人員除持續監測維持生命徵象穩定，亦採同理心、陪伴，達成信任護病關係，使病人接受急救復甦後照護。事後突發急症雖已治療，但未完成預定手術，膝關節疼痛尚未解決，持續利用電訪關懷了解返家自我照護情況，依其不足處予個別補強；另因全脊髓麻醉合併症需即時處置，建議增加相關教育訓練，讓醫護團隊有效地辨別及處理緊急情況，維持最佳病人照護品質。

Although its incidence is extremely low, total spinal anesthesia is a serious complication. Emergent management is required to prevent mortality. This paper presents the case of a 75-year-old woman scheduled for total knee arthroplasty. She presented with cardiac arrest, and electrocardiography revealed pulseless electrical activity. Cardiopulmonary resuscitation was performed immediately, and the patient was transferred to the recovery room. The patient was cared for between 8:50 a.m. and 5:00 p.m. on February 18, 2021. Data from physical assessments, observations, family interviews, and medical records were collected. Gordon's 11 Functional Health Patterns were used to assess the patient's health problems, which were insufficient cardiac output, gas exchange disorder, and anxiety. When the patient woke up, she was panicked and uncooperative because she was frightened by the unexpected need for invasive procedures. The nurse monitored and maintained the patient's vital signs, interacted with the patient with empathy, and provided her information, thereby building trust. Consequently, the patient agreed to postresuscitation care. During recovery, the patient experienced knee pain. We followed up with her and provided assistance over the phone. Caregivers should be properly educated about total spinal anesthesia because of its time sensitivity. Medical teams should work efficiently to manage emergencies and ensure that patients receive high-quality care.

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