照顧一位胸腺瘤行胸腔縱膈腫瘤切除術個案之手術全期經驗

Experience of Taking Care of a Case of Thymoma Undergoing Thoracoscopic Mediastinal Tumor Resection

10.6647/CN.202209_29(3).0011

蔡美慧(Mei-Hui Tsai)；朱雅芬(Ya-Fen Chu)

胸腺瘤 ； 胸腔鏡 ； 手術全期護理 ； 肌無力危象 ； 膽鹼能危象 ； Thymoma ； Thoracoscopy ； Full-Term Care of Surgery ； Myasthenic Crisis ； Cholinergic Crisis

彰化護理

29卷3期（2022 / 09 / 01）

85 - 97

繁體中文

本文描述一位胸腺瘤併肌無力症行胸腔鏡縱膈腫瘤切除手術個案，於術前訪視發現個案雖答應行手術治療，但對於是否接受手術仍猶豫不決，希望能延期手術讓自己有更多時間考慮，筆者同理個案徬徨之心，為避免決策後悔及治療延遲，引發深入探討動機，筆者於2021年3月24日至4月1日照護期間，運用身體、心理、智能、社會、靈性進行整體性評估，藉由訪視及透過觀察、會談、傾聽及身體評估等方式收集資料，確立個案有決策衝突、潛在危險性手術情境的傷害、急性疼痛及潛在危險性危象－肌無力及膽鹼能危象。醫療團隊於會議中利用醫療決策輔助工具幫助個案了解手術相關事項，以利選擇治療方式；術中密切監測生命徵象及醫療團隊一同照護預防術中的手術傷害；術後利用藥物及非藥物來減輕疼痛之不適；並透過文獻查證了解胸腺瘤術後合併症，利早發現及早治療。為促進醫療人員間的互相學習，建議病房晨間會議邀請手術室人員參與一同討論及訂製護理計畫，將討論注意事項及照護方式統整放置院內網路平台，可使醫護人員照護參考。

This Article Describes a Case of Thymoma with Myasthenia Who Underwent Thoracoscopic Mediastinal Tumor Resection. During the Preoperative Visit, It Was Found that Although the Patient Agreed to Undergo Surgery, He was Still Hesitant about Whether to Accept the Surgery. More Time to Consider, the Author Empathizes with the Hesitant Heart of the Case. In Order to Avoid Decision-Making Regrets and Treatment Delays, Triggering in-Depth Discussion of Motivation, the Author will Use Physical, Psychological, Intellectual, Overall Assessment of Society and Spirituality, Through Visits and Data Collection Through Observation, Interview, Listening and Physical Assessment, etc., to Establish that the Case Has Decision-Making Conflicts, Injuries in Potentially Dangerous Surgical Situations, Acute Pain and Potentially Dangerous Crises- Myasthenia and Cholinergic Crisis. During the Meeting, the Medical Team Uses Medical Decision Aids to Help the Case Understand the Matters Related to the Operation, so as to Facilitate the Selection of Treatment Methods; Closely Monitor the Vital Signs During the Operation and Take Care of the Medical Team to Prevent the Surgical Injury During the Operation; Use Drugs and Non-Drugs to Relieve Pain after Surgery. Uncomfortable; and Through literature Verification to Understand the Postoperative Complications of Thymoma, to Facilitate Early Detection and Early Treatment. In Order to Promote Mutual Learning Among Medical Personnel, it is Recommended that the Ward Morning Meeting Invites the Operating Room Personnel to Participate in the Discussion and Customize the Nursing Plan. The Discussion Points and Care Methods are Placed on the Hospital Network Platform, so that Medical Personnel Can Refer to the Care.

1. 劉昭宇(2018)。臺灣胸腔鏡手術之發展與創新。臨床醫學，81(4)，197-203。
   連結：
2. Cata, J. P.,Lasala, J. D.,Williams, W.,Mena, G. E.(2019).Myasthenia gravis and thymoma surgery: a clinical update for the cardiothoracic anesthesiologist.Journal of cardiothoracic and vascular anesthesia,33(9),2537-2545.
3. Daum, P.,Smelt, J.,Ibrahim, I. R.(2021).Perioperative management of myasthenia gravis.BJA Education,21(11),414-419.
4. Menon, D.,Katzberg, H.,Barnett, C.,Pal, P.,Bezjak, A.,Keshavjee, S.,Bril, V.(2021).Thymoma pathology and myasthenia gravis outcomes.Muscle & Nerve,63(6),868-873.
5. Minervini, F.,Kocher, G. J.(2020).When to suspect a thymoma: clinical point of view.Journal of thoracic disease,12(12),7613.
6. Narayanaswami, P.,Sanders, D. B.,Wolfe, G.,Benatar, M.,Cea, G.,Evoli, A.,Gilhus, N. E.,Illa, I.,Kuntz, N. L.,Massey, J.,Melms, A.,Murai, H.,Nicolle, M.,Palace, J.,Richman, D.,Verschuuren, J.(2021).International consensus guidance for management of myasthenia gravis: 2020 update.Neurology,96(3),114-122.
7. 任秀如(2012)。手術全期護理。醫療品質雜誌，6(3)，27-30。
8. 李旻燕,蘇郁庭,侯雅萍(2020)。手術室護理師術前訪視改善專案之成效。健康促進研究與實務，3(2)，39-48。
9. 黃瓊慧,吳貞慧,張怡華,賈如瓊,張璇其,洪曉佩(2017)。全身麻醉病人術後介入保暖措施改善低體溫之成效探討。健康與建築雜誌，4(2)，88-94。
10. 楊榮森,楊宗翰(2021)。手術之醫病共享決策。台灣醫學，25(1)，111-117。
11. 衛生福利部（2021，6月18日）‧109年度死因統計。 https://dep.mohw.gov.tw/DOS/lp-5202-113.html