一位多發性硬化症病人行腦部立體定位切片之手術全期護理

The Perioperative Nursing Experience of Caring for a Patient with Multiple Sclerosis Undergoing Stereotactic Needle Biopsy of Intracranial Tumors

10.6540/NTJN.202303_25(1).0010

許騫燕(Chien-Yen Hsu)；陳禕瑋(Yi-Wei Chen)；陳幸姬(Hsing-Chi Chen)

手術全期護理 ； 腦部立體定位切片手術 ； 多發性硬化症 ； preoperative nursing ； stereotactic needle biopsy of intracranial tumors ； multiple sclerosis

新臺北護理期刊

25卷1期（2023 / 03 / 01）

107 - 118

繁體中文;英文

本文描寫一位34歲男性在接受腦部立體定位切片手術後確診為多發性硬化症的照護經驗。由於個案熱愛健身卻因右腳無力，導致減少運動，且為初次手術，所以術前呈現重度焦慮。因筆者感受到個案的無助，且查詢近五年國內少有多發性硬化症接受立體定位手術相關文獻，因而引發筆者的動機，照護期間為2019年5月30日至6月28日，運用Gordon十一項健康功能型態評估，確立問題為焦慮、急性疼痛、增進知識準備度、潛在危險性損傷，經由筆者提供情緒支持，並澄清錯誤資訊後，有效將其焦慮降至極輕微。最後建議照護多發性硬化症的手術病人時，需評估其症狀是否影響日常活動，並尊重喜好讓其參與照護，最終能恢復其生活形態，達到手術全期護理目標。

This article describes the nursing experience of a 34-year-old man who was diagnosed with multiple sclerosis after undergoing stereotactic needle biopsy of intracranial tumors. Because this was the patient's first operation, and he was worried about postoperative limb recovery, he had severe anxiety before surgery. Because the author felt the case's helplessness, and there were few domestic MS receiving stereotactic surgery-related literature in the past five years, these prompted the author's caring motivation. The nursing period was from May 30, 2019 to June 28, 2019. Using Gordon 11 Function Health Patterns, the case's problems were identified as anxiety, acute pain, readiness for enhanced knowledge, and the risk for injury. After the author provided emotional support and clarified wrong information, these measures effectively reduced his anxiety to minimal and he was discharged from the hospital. Finally, it is recommended that when caring for patients with multiple sclerosis, it is necessary to assess whether their symptoms will interfere with daily activities, and respect their preferences to allow them to participate in nursing care, and finally, they can take care of themselves after returning home.

1. Brownlee, W. J.,Hardy, T. A.,Fazekas, F.,Miller, D. H.(2017).Diagnosis of multiple sclerosis: progress and challenges.The Lancet,389(10076),1336-1346.
2. Crosley, K. M.(2018).Perioperative care during deep brain stimulation surgery.AORN journal,108(2),148-153.
3. Dagona, S.S.,Archibong, U. E.,McClelland, G. T.(2018).Preference of non-pharmaceutical preoperative anxiety reduction intervention in patients undergoing elective surgery.Advances in Social Sciences Research Journal,5(12),311-323.
4. Dendrou, C. A.,Fugger, L.,Friese, M. A.(2015).Immunopathology of multiple sclerosis.Nature Reviews Immunology,15(9),545-558.
5. Georgiopoulos, M.,Ellul, J.,Chroni, E.,Constantoyannis, C.(2018).Efficacy, safety, and duration of a frameless fiducial-less brain biopsy versus frame-based stereotactic biopsy: a prospective randomized study.Journal of Neurological Surgery Part A: Central European Neurosurgery,79(01),31-38.
6. Hejrati, N.,Spieler, D.,Samuel, R.,Regli, L.,Weyerbrock, A.,Surbeck, W.(2019).Conscious experience and psychological consequences of awake craniotomy.World neurosurgery,129,e381-e386.
7. Jonsdottir, J.,Gervasoni, E.,Bowman, T.,Bertoni, R.,Tavazzi, E.,Rovaris, M.,Cattaneo, D.(2018).Intensive multimodal training to improve gait resistance, mobility, balance and cognitive function in persons with multiple sclerosis: a pilot randomized controlled trial.Fronties in neurology,9,800.
8. Madden, L. K.,Tham, P. K.,Shahlaie, K.(2019).Neurosurgical procedures: patient care management.The clinical practice of neurological and neurosurgical nursing,Philadelphia:
9. Malone, H.,Yang, J.,Hershman, D. L.,Wright, J. D.,Bruce, J. N.,Neugut, A. I.(2015).Complications following stereotactic needle biopsy of intracranial tumors.World neurosurgery,84(4),1084-1089.
10. Melchior, L. M. R.,Barreto, R. A. D. S. S.,Prado, M. A.,Caetano, K. A. A.,Bezerra, A. L. Q.,de Sousa, T. V.(2018).Predictors for moderate and serious pre-operatory anxiety in hospitalized surgical patients.Enfermeria Global,17(4),86-96.
11. 中央健保局（2020，7月3日）•全民健康保險重大傷病證明實際有效領證統計表•https://www.nhi.gov.tw/Content_List.aspx?n=D529CAC4D8F8E77B&topn=23C660CAACAA159D
12. 任秀如, H.J.(2012)。手術全期護理。醫療品質雜誌，6(3)，27-30。
13. 莊依菁, Y. C.,蔡佩玲, P. L.,廖玲巧, L. C.(2018)。多發性硬化症之藥物治療簡介。臺灣臨床藥學雜誌，26(3)，204-210。