一位經產婦產後出血引發心臟衰竭接受體外循環維生治療之加護經驗

Nursing Experience of Caring for a Multiparous Woman Who Had Cardiac Failure Due to Postpartum Hemorrhage and Received Extracorporeal Membrane Oxygenation

10.6142/VGHN.202303_40(1).0009

林至柔(Jhih-Rou Lin)；黃聖惠(Sheng-Huei Huang)；鍾幸枝(Hsing-Chi Chung)

產後出血 ； 心臟衰竭 ； 體外循環維生系統 ； postpartum hemorrhage ； cardiac failure ； extracorporeal membrane oxygenation

榮總護理

40卷1期（2023 / 03 / 01）

81 - 88

繁體中文;英文

本文描述一位33歲經產婦因產後出血引發心臟衰竭，使用體外循環維生系統治療，成功挽救病人生命的加護經驗。照護期間2020年10月21日至11月8日，筆者運用Gordon十一項功能性健康型態評估及觀察、身體評估、結構、非結構性會談及電話訪談等方式進行資料收集，確立病人健康問題為組織灌流改變、呼吸道清除功能失效及照顧者角色緊張等三項健康問題。照護期間啟動跨領域團隊合作照護，監測血液動力學變化並介入體外循環維生系統，減少心臟負荷進而改善心臟損傷情形；擬定復健運動計畫及教導正確咳嗽技巧，以增進有效咳痰能力進而成功脫離呼吸器；透過傾聽關懷並凝聚家庭力量分擔其壓力，透過學習照護技能增強自信以緩解焦慮，順利解決病人各項健康問題；建議國內成立產後出血病人之支持團體，可提供完善的諮詢達到連續性照護，期望藉此護理經驗分享，提供同仁照護參考。

This article describes the case of a 33-year-old multiparous woman who received extracorporeal membrane oxygenation (ECMO) for cardiac failure due to postpartum hemorrhage. The nursing period was from October 21, 2020, to November 8, 2020. Through the use of 11 functional health patterns proposed by Gordon, relevant data were collected by evaluating the patient's physical condition and conducting structured, unstructured, and telephonic interviews. The following health issues were identified: altered tissue perfusion, failed airway clearance, and caregiver stress. An interdisciplinary team monitored the patient's hemodynamic changes. ECMO was performed to reduce cardiac load and improve cardiac damage. In addition, a rehabilitation exercise program was designed, and appropriate cough techniques were taught to promote effective expectoration and successful weaning from the respirator. Care was also provided to the patient's family members by listening to them and enhancing family cohesiveness to alleviate their stress. The researcher learned caring skills to confidently resolve the patient's health problems. Support groups for patients with postpartum hemorrhage should be established in Taiwan to provide complete counseling and ensure continual care. Our experience may guide nurses in caring for similar patients.

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