協助一位初診斷肝癌病人首次接受經導管肝動脈化學栓塞術之護理經驗

The Experience Nursing of Assist in the Early Diagnosis of Hepatic Carcinoma Patient Who Received First Transcatheter Arterial Chemoembolization

10.3966/168395442018061801009

吳柳秀(Wu-Liu Hsiu)；宋聖芬(Sheng-Fen Sung)；洪玉玲(Yu-Ling Hung)

初診斷肝癌 ； 經導管肝動脈化學栓塞術 ； 知識缺失 ； The First Diagnosis of Hepatocellular Carcinoma ； Transarterial Chemoembolization (TACE) ； knowledge missing

腫瘤護理雜誌

18卷1期（2018 / 06 / 01）

107 - 118

繁體中文

本文探討協助一位初診斷肝癌患者首次接受經導管肝動脈化學栓塞術治療，個案與案妻因缺乏肝癌知識及不瞭解治療過程，導致個案焦慮及照顧者角色緊張之護理經驗。護理期間從2014年11月18日至2014年11月25日，筆者經由觀察、直接照護，經整體評估後，發現個案的健康問題有：知識缺失、焦慮、急性疼痛及照顧者的角色緊張。經與個案及照顧者共同擬訂具個別性及整體性之護理計畫，運用關懷、同理心等技巧與個案建立互信關係，扮演傾聽、支持及諮詢者的角色，引導個案訴說擔心害怕的事，協助渡過首次罹癌及接受經導管肝動脈化學栓塞術過程的不安情緒；應用肝癌照護手冊，指導個案及家屬經導管肝動脈化學栓塞術治療前後照護之知識，以增進對經導管肝動脈化學栓塞術相關合併症之瞭解；透過深呼吸、音樂療法，協助減輕個案疼痛；評估到照顧者負荷問題後，提供照護技巧回覆示教，以降低照顧者角色緊張。筆者在護理過程中，除提供照顧知識及技能外，並給予個案及照顧者心理支持，扮演各部門間溝通橋樑，適時轉介結合相關病友協會，促使個案及主要照顧者能獲得完善及持續性照護。

The aim for this article is to explore the nursing patient care related to the initial diagnosis of hepatic carcinoma and first time transarterial chemoembolization (TACE) therapy. The patient's anxiety and his wife's apprehension as caregiver was a result from lack of knowledge in hepatic carcinoma and the treatment process. During the period from November 18 to November 25 in 2014, the author identified the patient's problems to be: lack of knowledge, acute pain, anxiety, and caregiver role strain. Author, by using the Gordon's Eleven Functional Health Patterns Nursing Assessment, showed the patient and wife the benefits and importance of spiritual wellbeing, continuous companionship, trust between patient and his wife. In order to lower the anxiety level, author also provided essential information to assist the patient and his wife to understand hepatic carcinoma, and also to understanding the hepatic artery chemical embolization process, anxiety stages, being present and showing empathy throughout the treatment.

1. 溫明寰, M. H.,林宜演, I. Y.,張育綺, Y. C.(2016)。載藥微球肝動脈栓塞術簡介及護理。榮總護理，33(2)，134-140。
   連結：
2. 蘇僅涵, C. H.,蔣立琦, L. C.(2017)。以系統性文獻綜整減輕癌症家庭照顧者焦慮及憂鬱之組合式護理措施。源遠護理雜誌，11(1)，5-11。
   連結：
3. Cabrera, R.,Nelson, D. R.(2010).Review article: The management of hepatocellular carcinoma.Alimentary Pharmacology and Therapeutics,31(4),461-476.
4. Cao, W.,Li, J.,Hu, C.,Shen, J.,Liu, X.,Xu, Y.,Ye, Z.(2013).Symptom clusters and symptom interference of HCC patients undergoing TACE: A cross-sectional study in China.Supportive Care in Cancer,21(2),475-483.
5. De Lope, C. R.,Tremosini, S.,Forner, A.,Reig, M.,Bruix, J.(2012).Management of HCC.Journal of Hepatology,56(Suppl. 1),75-87.
6. Harding, R.,Gao, W.,Jackson, D.,Pearson, C.,Murray, J.,Higginson, I. J.(2015).Comparative analysis of informal caregiver burden in advanced cancer, dementia, and acquired brain injury.Journal of Pain and Symptom Management,50(4),445-452.
7. Huang, S. T.,Good, M.,Zauszniewski, J. A.(2010).The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial.International Journal of Nursing Studies,47(11),1354-1362.
8. Kogut, M. J.,Chewning, R. H.,Harris, W. P.,Hippe, D. S.,Padia, S. A.(2013).Postembolization syndrome after hepatic transarterial chemoembolization: Effect of prophylactic steroids on postprocedure medication requirements.Journal of Vascular and Interventional Radiology,24(3),326-331.
9. Lencioni, R.,Petruzzi, P.,Crocetti, L.(2013).Chemoembolization of hepatocellular carcinoma.Seminars in Interventional Radiology,30(1),3-11.
10. Marrero, J. A.,Ahn, J.,Rajender Reddy, K.(2014).ACG clinical guideline: The diagnosis and management of focal liver lesions.The American Journal of Gastroenterology,109(9),1328-1347.
11. Shun, S. C.,Chen, C. H.,Sheu, J. C.,Liang, J. D.,Yang, J. C.,Lai, Y. H.(2012).Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization treatment: A longitudinal study.The Oncologist,17(5),732-739.
12. World Health Organization. (2015). GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. Retrieved from http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
13. 吳尚倫, S. L.,謝政智, C. C.(2017)。癌症相關疼痛之藥物治療新觀念。臺灣臨床藥學雜誌，25(2)，100-108。
14. 廖幼婕, Y. C.(2014)。癌症病人之配偶所面對的心理社會衝擊。腫瘤護理雜誌，14(增訂=suppl.)，1-12。
15. 劉鐘軒, C. H.,蔡正中, C. C.,陳海雄, H. H.(2013)。肝癌的診斷及治療最新發展。內科學誌，24(2)，85-94。
16. 衛生福利部國民健康署（2017，12月14日）．2014年癌症登記年報．取自http://www.hpa.gov.tw/Bhpnet/Web/Stat/StatisticsShow.aspx-?No=201504290001.pdf。[Ministry of Health and Welfare (2017, December 27). 103 years cancer registry annual report. Retrieved from http://www.hpa.gov.tw/Bhpnet/Web/Stat/ Statistics Show.aspx?No=201504290001.pdf]

1. 簡靜慧,陳姿廷,周蜜淳,呂佩珍(2019)。運用Miller金字塔理論提升護理人員執行肝動脈化療栓塞術護理指導成效之專案。健康科技期刊，5(2)，12-21。