一位毛毛樣腦血管疾病術後成功脫離呼吸器個案之護理經驗

The Nursing Experience Regarding a Patient with Moyamoya Disease after Successful Ventilator Weaning after Surgery

10.6692/KJN.202208_39(2).0006

黎素妤(Su-Yu Li)；李姿月(Zi-Yue Li)；曾瓊誼(Chun-Yi Tseng)

毛毛樣腦血管疾病 ； 脫離呼吸器 ； 焦慮 ； Moyamoya disease ； detachment from respirator ； anxiety

高雄護理雜誌

39卷2期（2022 / 08 / 01）

65 - 77

繁體中文

本文探討一位毛毛樣腦血管疾病術後成功脫離呼吸器之護理經驗，護理期間自2019年7月31日至2019年8月26日，運用Gordon十一項健康功能評估，以觀察、直接照護及筆談等收集資料，確立健康問題為：呼吸機戒斷反應功能失常、顱內壓調適能力降低、焦慮。住院期間個案輾轉面對腦部手術和呼吸器脫離失敗的身心煎熬，增添害怕與焦慮的負向情緒，故首先與個案建立良好的護病關係，借助醫病共享決策及團隊合作的精神，讓個案發揮醫療自主權決定氣切手術，利用漸進式呼吸訓練模式，與個案討論呼吸器脫離計畫，安排個別性之胸腔復健運動及高頻胸壁震盪機的使用時機，改善呼吸道負荷症狀並強化呼吸肌耐力。在呼吸訓練過程，密切觀察生命徵象，避免顱內壓上升，同時播放個案喜愛的音樂配合深呼吸運動，有效轉移注意力，舒緩緊張情緒，進而成功脫離呼吸器，回歸日常生活。希望藉此文獻探討及護理經驗的分享，作為日後臨床照護之參考。

The purpose of this abstract is to examine the nursing experience of a patient with Moyamoya disease after successful ventilator weaning following surgery. During the period of July 31 to August 26 in 2019, Gordon's 11 functional health patterns assessment was used, by observation, direct care and written conversations, to determine the health problems of the patient. The problems were discovered to be dysfunctional ventilatory weaning response, decreased intracranial pressure adjustment ability and anxiety. During the hospitalization, the patient faced the suffering of brain surgery and ventilator weaning failure, adding more negative emotions such as fear, anxiety and worry in the patient. Thus, a good nursing relationship with the patient was first established. By adopting the principles of shared decision-making and teamwork between the doctor and patient, the decision to perform tracheostomy was made under the patient's willingness. Under progressive breathing training mode, the ventilation weaning plan, personalized pulmonary rehabilitation exercise and the timing to implement high frequency chest wall oscillation were discussed and arranged to improve the respiratory symptoms and strengthen the endurance of respiratory muscles of the patient. During the respiratory training process, vital signs were observed carefully to avoid any increase in intracranial pressure while at the same time, the patient's favorite music was broadcasted and combined with the deep breathing exercise. This effectively diverted the attention and relieved the tension of the patient, which in turn resulted in the success of ventilator weaning. Through this article and discussion, the author hopes to share her nursing experience as a reference for future clinical care.

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