一位重症肌無力個案面臨初次重症肌無力危象之護理經驗

The Nursing Experience of Caring a Patient Facing Myasthenic Crisis the First Time

10.6386/CGN.202009_31(3).0008

潘怡旻(Yi-Min Pan)

重症肌無力危象 ； 低效性呼吸型態 ； 吞嚥障礙 ； 無力感 ； myasthenic crisis ； ineffective breathing pattern ； dysphagia ； powerlessness

長庚護理

31卷3期（2020 / 09 / 01）

395 - 403

繁體中文

本文描述一位重症肌無力個案面臨初次重症肌無力之護理經驗。照護期間自2017年8月18日至2017年9月4日止，藉由觀察、會談、身體評估等方式，運用Gordon11項健康功能型態評估分析資料，歸納出主要護理問題有：低效性呼吸型態、吞嚥困難及無力感。透過呼吸肌訓練維持氧合及增加肺活量；教導正確的鼻胃管灌食技巧及協助吞嚥訓練，終使其移除鼻胃管順利由口進食；主動關懷、引導個案說出內心感受，協助調適負向情緒，並提供疾病知識、家人與團體支持，使其以正向的態度重建自我價值，有效提升個案之生活品質。盼藉此篇護理經驗分享，提供給日後照護初次面臨重症肌無力危象個案之護理人員做為參考。

This article described the care of a myasthenia gravis patient facing her first time myasthenic crisis. The duration of nursing care was from August 18th to September 4th, 2017. Based on the Gordon's 11 Functional Health Patterns, three health problems were identified: ineffective breathing pattern, dysphagia, and powerlessness. Here is our strategy. First, we instructed the patient in respiratory rehabilitation exercises to relieve physical discomfort and increase vital capacity. Second, teaching correct nasogastric feeding skills and swallowing training facilitated nasogastric tube removal. Third, we encouraged the patient to express thoughts and adjust the negative emotions, provided the disease information and group support, and helped the patient to rebuilding self-esteem and improved the quality of life. The author shares this particular nursing care experience in the first time facing myasthenic crisis patient as a reference for future clinical care.

1. 吳虹諗, H. S.,張巧惠, C. H.,陳麗貞, L. C.,林梅香, M. H.,,謝春蘭, C. L.(2015)。加護病房護理人員鼻胃管灌食照護完整性之改善專案。長庚護理，26(1)，53-65。
   連結：
2. Chen, Y. T.,Shih, F. J.,Hayter, M.,Hou, C. C.,Yeh, J. H.(2013).Experiences of living with myasthenia gravis: A qualitative study with Taiwanese people.Journal of Neuroscience Nursing,45(2),E3-E10.
3. Prigent, H.,Orlikowski, D.,Letilly, N.,Falaize, L.,Annane, D.,Sharshar, T.,Lofaso, F.(2012).Vital capacity versus maximal inspiratory pressure in patients with Guillain–Barré syndrome and myasthenia gravis.Neurocritical care,17(2),236-239.
4. Volsko, T. A.(2013).Airway clearance therapy: Finding the evidence.Respiratory care,58(10),1669-1678.
5. Wong, Y. S.,Ong, C. T.,Sung, S. F.,Wu, C. S.,Hsu, Y. C.,Su, Y. H.,Hung, L. C.(2016).Clinical profile and outcome of myasthenic crisis in Central Taiwan.Acta Neurologica Taiwanica,25(4),129-135.
6. Ybarra, M. I.,Kummer, A.,Frota, E. R. C.,Oliveira, J. T. D.,Gomez, R. S.,Teixeira, A. L.(2011).Psychiatric disorders in myasthenia gravis.Arquivos de neuro-psiquiatria,69(2A),176-179.
7. 洪淑芬, S. F.,葉惠慈, T. H.,楊黛芬, D. F.,李佳佳, L. H.,古雪貞, H. C.(2016)。提升呼吸器依賴病人肺部復健運動執行率之方案。馬偕護理雜誌，10(1)，33-46。
8. 童俊欽, C. C.,李建瑩, C. Y.,蔡敏鈴, M. L.(2012)。重症肌無力症患者的藥物使用。藥學雜誌，28(2)，95-98。
9. 馮清世, Q. S.(2011)。重症肌無力症病理機轉與抗體診斷的最近進展。當代醫學，447，54-59。
10. 葉月珍, Y. C.,馬素華, S. W.(2002)。「無力感」之概念分析。長庚護理，13(2)，146-151。
11. 葉建宏, J. H.,邱浩彰, H. C(2010)。重症肌無力危象之血漿分離療法。重症醫學雜誌，11(2)，80-89。
12. 盧釆臻, C. J.,張麟鳳, L. F.,洪蘆妍, L. Y.,彭淑苹, S. P.(2015)。護理人員協助執行腦中風病人吞嚥訓練之指引及現況。榮總護理，32(2)，202-207。
13. 賴玉琪, Y. C.(2014)。重症肌無力。嘉基藥訊，144，1-3。
14. 賴怡君, Y. J.,王桂芸, K. Y.,陳金彌, C. M.(2011)。吞嚥困難之概念分析。源遠護理，5(2)，56-62。

1. 陳衍喬,許家禎,吳貞蓉,朱玉珊(2022)。照顧一位重症肌無力危象病人之加護經驗。嘉基護理，22(2)，58-67。