一位食道癌末期併氣管食道廔管個案之重症照護

Critical Care for a Patient with End-Stage Esophageal Cancer Complicated by Tracheoesophageal Fistula

陳陶霈瑜(Pei-Yu ChenTao)；葉惠玲(Hui-Ling Yeh)

食道癌 ； 氣管食道廔管 ； 舒適障礙 ； 醫療自主 ； esophageal cancer ； impaired comfort ； medical autonomy ； tracheoesophageal fistula

志為護理-慈濟護理雜誌

22卷2期（2023 / 04 / 01）

77 - 86

繁體中文;英文

本文是一位中年男性食道癌末期併氣管食道廔管之重症經驗，照護自2019年3月7日至26日，以生理、心理、社會及靈性四大層面進行整體性評估，以直接照護、身體評估、觀察、筆談、醫療緩和家庭諮詢會議確立個案有呼吸道清除功能失效、舒適障礙、家庭衝突等健康問題。護理期間使用低壓力抽吸管抽吸口腔分泌物，維持呼吸道通暢及血氧濃度大於95%；依照自覺半坐臥舒服姿勢，協助臀部放置脂肪墊減壓，改善背臀痠痛；鼓勵個案筆談表達感受，安排家庭會議及安寧共照，尊重個案醫療自主，並親簽預立安寧緩和醫療暨維生醫療抉擇意願書，最後陪伴個案達成善終。期望此護理經驗提供日後照護此類似個案之臨床參考。

This paper presents the author's experience in providing critical care to a middle-aged male patient with end-stage esophageal cancer complicated by tracheoesophageal fistula from March 7 to March 26, 2019. The physiological, psychological, social, and spiritual conditions of the patient were comprehensively evaluated. Through direct care, physical assessment, observation, conversation by writing, and a family meeting, the patient was confirmed to be confronted with several health problems. Problems included, insufficient airway clearance, impaired comfort, and family conflicts. During care, a low-pressure suction tube was used to remove the oral secretions of the patient to keep his airway unobstructed and his blood oxygen concentration higher than 95%. According to his self-assessed comfortable semirecumbent position, the patient was assisted in placing a fat pad on his buttock to reduce pressure and mitigate back and buttock soreness. The patient was encouraged to express his own feelings by writing. Family meetings and hospice shared care were arranged. The medical autonomy of the patient was respected. The patient also personally signed the Hospice Pallative Care & Life-Sustaining Treatment Advance Care Plan and was accompanied until the peaceful end of his life. The nursing experience described in this paper serves as a reference for providing clinical care to similar case patients in future.

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