運用肺部復健運動協助一位老年流感重症病人呼吸器脫離之護理經驗

Applying Pulmonary Rehabilitation to Assist an Elderly with Serious Influenza Complications Undergoing Weaning from Mechanical Ventilation

呂宛娟(Wan-Juan Lu)；鄭巧驊(Qiao-Hua Zheng)；高綺吟(Chi-Yin Kao)

焦慮 ； 肺部復健運動 ； 流感重症 ； 呼吸器脫離平衡 ； anxiety ； pulmonary rehabilitation ； serious influenza complications ； weaning from mechanical ventilator

嘉基護理

22卷1期（2022 / 06 / 01）

64 - 72

繁體中文

本文描述一位老年個案因流感引發呼吸窘迫置放體外循環維生系統，擔心呼吸器脫離成效不佳需執行氣切手術，導致個案焦慮之加護經驗。護理期間自2018年9月12日～26日，藉由照護觀察、身體評估、筆談、病歷查閱等方式收集資料，運用生理、心理、社會及靈性四大層面進行整體性評估，確立護理問題為低效性呼吸型態、潛在危險性感染、焦慮。透過肺部復健運動讓個案感受到肌力的進步，進而降低焦慮對脫離呼吸器有信心。最終成功脫離呼吸器並順利轉出加護病房。期藉此照護經驗讓護理師應用於臨床重症個案，提升照護品質。

This article describes an elderly with serious influenza complications experiencing acute respiratory failure and receiving extracorporeal membrane oxygenation. The uncertainty during waning from mechanical ventilation and fear of receiving tracheostomy resulted in the patient anxiety. Data were collected via observation, physical examination, interviews, and medical records between 12 September and 26 September 2018. We found the patient's health problems included ineffective breath pattern, risk of infection, and anxiety. Pulmonary rehabilitation was applied to enhance respiratory and to reduce anxiety assisting the patient with weaning from mechanical ventilator. Finally, the weaning was successful and the patient was transferred out of the ICU. This case report is hoped to provide health professionals with as a reference when caring such patients in order to improve care quality.

1. 蔣昀孜,葉美玲,劉介宇(2018)。呼吸放鬆改善中風病人自律神經、疲憊、焦慮、壓力與生活品質之成效。長庚護理，29(3)，325-336。
   連結：
2. 鍾旻珊,黃琪津,葉淑玲,林月娥,賀倫惠,陳淑卿(2016)。肺部復健運動介入對使用呼吸器重症病患之成效－系統性文獻回顧。護理雜誌，63(3)，94-104。
   連結：
3. Abuatiq, A.(2015).Patients’and health care providers’ perception of stressors in the intensive care units.Dimensions of Critical Care Nursing,34(4),205-214.
4. Alessandri, F.,Pugliese, F.,Ranieri, V. M.(2018).The role of rescue therapies in the treatment of severe ARDS.Respiratory Care,63(1),92-101.
5. Chen, Y. H.,Lin, H. L.,Hsiao, H. F.,Chou, L. T.,Kao, K. C.,Huang, C. C.,Tsai, Y. H.(2012).Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation.Respiratory Care,57(5),727-734.
6. Karlsson, V.,Lindahl, B.,Bergbom, I.(2012).Patients’ statements and experiences concerning receiving mechanical ventilation: A prospective video‐recorded study.Nursing Inquiry,19(3),247-258.
7. Karnatovskaia, L. V.,Johnson, M. M.,Benzo, R. P.,Gajic, O.(2015).The spectrum of psychocognitive morbidity in the critically ill: A review of the literature and call for improvement.Journal of Critical Care,30(1),130-137.
8. Prado, P. R. D.,Bettencourt, A. R. D. C.,Lopes, J. D. L.(2019).Related factors of the nursing diagnosis ineffective breathing pattern in an intensive care unit.Revista Latino-americana De Enfermagem,27,e3153.
9. Ward, D.,Fulbrook, P.(2016).Nursing strategies for effective weaning of the critically ill mechanically ventilated patient.Critical Care Nursing Clinics,28(4),499-512.
10. 王甯祺(2017)。新興傳染病流行趨勢。台北市醫師公會會刊，61(12)，52-54。
11. 吳方瑜,黃翠媛,陳玉娟(2018)。老化的生理變化與護理。老年護理學
12. 吳梅嵐,盧延洲,梁雅婷,蔡東霖,葉信住,黃俊立,賴柏伸,歐陽志佩(2019)。體外循環維生系統在流感併發急性呼吸窘迫症候群之運用。北市醫學雜誌，16(1)，60-66。
13. 李秋香,張淑華,王素美,賴慶祥,賴美玉(2015)。音樂介入對使用呼吸器患者之焦慮成效探討－前驅性研究。澄清醫護管理雜誌，11(1)，31-38。
14. 張美玉,劉慧玲(2011).實用重症護理學.五南.
15. 童惠芳,白玉珠,林柏瑤,陳美娟,蔡雅琪(2012)。分析手臂運動訓練對病人脫離呼吸器之成效。護理暨健康照護研究，8(2)，138-148。
16. 廖敏季,邱靜娥,簡榮彥,蔡志欣(2013)。復健運用於長期呼吸器依賴病人之成效。台灣醫學，17(5)，468-475。
17. 劉駿熒,涂冠宇,林秀縵,葉瓊璣(2014)。比較不同吸─呼比率之慢速呼吸對門診焦慮患者之影響。醫學與健康期刊，3(1)，57-66。
18. 衛生福利部疾病管制署（2018，12 月 1 日）‧傳染病統計資料查詢系統 ‧ 取自https://reurl.cc/mdgMoY
19. 衛生福利部疾病管制署（2018）‧流感併發重症‧取自 https://www.cdc.gov.tw/File/Get/ 0-JQyxIANAm5pYl7F83HSw
20. 邊苗瑛,龍芳,林佑穗,楊式興(2010)。體外膜氧合治療的臨床使用。呼吸治療，9(1)，41-52。