照顧一位福爾尼埃氏壞疽男性病人之加護經驗

Intensive Care Provided to a Male Patient with Fournier's Gangrene

廖恩亭(En-Ting Liao)；蕭佳玲(Chia-Ling Hsiao)；陳雅惠(Ya-Huei Chen)；黃智傑(Jyh-Jye Huang)

福爾尼埃氏壞疽 ； 呼吸器脫離訓練 ； 組織完整性受損 ； 身體心像紊亂 ； Fournier's gangrene ； Ventilator weaning ； Impaired tissue integrity ； Disturbed body image

澄清醫護管理雜誌

20卷4期（2024 / 10 / 01）

46 - 54

繁體中文;英文

本文為一位福爾尼埃氏壞疽男性，面對大範圍肛門、生殖器周圍皮膚受損，至手術室行筋膜切開與傷口清創手術，因氣管內管無法依計畫拔除入住加護病房之護理經驗。照護期間為2022年4月13日至5月5日，藉由直接照護、身體評估、紙筆溝通及病歷查閱等方式收集資料，並運用Gordon十一項功能性健康型態評估，歸納健康問題為：組織完整性受損、呼吸機脫離反應功能失常及身體心像紊亂。照護措施有：首先在傷口照護執行無菌技術，每日標記傷口範圍及記錄，與跨領域團隊成員討論傷口復原狀況；並穩定氧合及制定肺部復健運動計畫，運用高頻胸壁振盪輔助器具及教導個案呼吸咳嗽技巧改善肺部負荷，協助成功脫離呼吸器；利用鏡子的反射看清楚傷口外觀，增進個案對腸造口的認知，提供相關照護衛教單張指導及造口模型，學習腸造口黏貼操作，並討論造口去除異味方法，以增加對疾病的正向看法；因筆者本身在諮商技巧較不熟捻且考量個案體力負荷為重，時常藉由片段耗時間，收集資料與提供心理支持，建議單位可增設此類個案衛教素材，並定期討論困難傷口的個案，增進單位同仁的傷口照護技能，協助儘早加強個案出院的自我照護能力，提升生活品質，冀望藉此分享提供臨床照護之參考。

This paper describes the intensive care provided to a male patient with Fournier's gangrene, characterized by extensive skin damage in the anal and genital areas. The patient underwent surgical fasciotomy and wound debridement in the operating theatre and was subsequently admitted to the intensive care unit, as the endotracheal tube could not be removed as originally planned. The care period was from 13 April to 5 May 2022. Data were collected through direct care, physical assessment, written communication, and medical record review. Gordon's 11 Functional Health Patterns were utilized to assess and summarize the patient's health issues, which included impaired tissue integrity, dysfunctional ventilatory weaning response, and disturbed body image. Nursing interventions included use of sterile wound care techniques, along with daily marking and recording of wound size. Interdisciplinary discussions on wound recovery were also conducted. Oxygenation was stabilized, and a pulmonary rehabilitation exercise plan was developed. This plan used a high-frequency chest wall oscillation device and included teaching the patient breathing and coughing techniques to improve lung capacity and facilitate successful ventilator weaning. A mirror was used to enhance the patient's awareness of their colostomy. The patient was provided with relevant care and educational materials, as well as stoma models, to facilitate the learning of colostomy system application. Additionally, techniques for stoma odor elimination were discussed, promoting a more positive outlook. Due to the author's limited counselling skills and patient's physical burden, data collection and psychological support provision were time-consuming and fragmented. We recommend that the department create educational resources for such cases and regularly discuss the treatment of difficult wound cases to enhance wound care techniques, facilitate early reinforcement of post-discharge self-care, improve patients' quality of life. This case report is intended to serve as a reference in clinical care.