照顧一位行縮胃手術病患反覆滲漏之護理經驗

Nursing Experience of Caring for a Patient Undergoing Sleeve Gastrectomy Who Experienced Repeated Wound Leakages

10.6647/CN.202306_30(2).0015

邱竹吟(Chu- Yin, Chiu)；黃璇如(Hsuan-Ju, Huang)

sleeve gastrectomy ； wound leakages ； nursing

彰化護理

30卷2期（2023 / 06 / 01）

137 - 150

繁體中文;英文

本文為描述一位因行縮胃手術因傷口滲漏導致住院面臨因應能力失調之照護經驗。照護期間，自2019年12月23日至2020年1月8日，照護過程中筆者運用Gordon十一項健康功能型態作為評估工具，發現病人有手術恢復延遲、增進營養的準備度、增進因應能力的準備度問題。護理期間運用同理心及醫療團隊詳細說明病情進展，使個案可正向面對身上的管路留置，減輕個案的擔憂並能正向表達病程變化及主動參與自我照顧方法；飲食上，指導個案採階段性飲食並觀察個案進食狀況，使個案獲取足夠營養；而當個案恢復狀況不如預期，產生擔心害怕，予以傾聽陪伴，並藉由醫療團隊設定治療目標及說明合併症發生及相關處置，並可於社工協助、家人支持下，使個案得以正視病況不如預期帶來的衝擊，使病人知悉治療目的與目標以減少心理壓力與恢復的信心，故期望由此經驗，提供日後照護類似個案之護理人員參考依據。

The nursing experience of caring for a patient undergoing sleeve gastrectomy who was hospitalized due to wound leakages and faced a lack of coping ability. During the nursing period from December 23th, 2019 to January 8th, 2020, on applying the eleven functional health patterns as described by Gordon, it was found the patient faced multiple health issues, such as delayed recovery from surgery, the need to increase nutritional readiness, and the need to increase the readiness of coping ability. During the nursing care, the researcher used empathy and the medical team provided detailed explanations on disease progress to enable the patient to face catheter indwelling in a positive way. This also helped in relieving the patient's worry and encouraging the patient to positively express the changes in the disease course and actively participate in the self-care method. In terms of diet, the researcher instructed the patient to implement a phased diet plan to enable the patient to intake sufficient nutrition. The patient experienced worry and fear due to failures to meet the expectation towards recovery and economic needs. Therefore, the researcher listened to the patient and accompanied the patient. Moreover, with the support and assistance from the medical team, social workers, and family, the patient was encouraged to learn coping skills, face the impact of the disease condition failing to meet the expectation, and regain hope for the future. The nursing experience may serve as a reference for nursing personnel caring for similar cases in the future.

1. 吳淑芬、宋天洲、許毓容（2021）‧減重手術後病人的營養需求與照護‧護理雜誌，68（3），21-25。https://doi.org/10.6224/JN.202106_68(3).04
   連結：
2. 呂忻僅、郭素娥（2017）‧減重手術後病人進食與營養狀況分析‧臺灣膳食營養學雜誌，9（1），29-39。https://doi.org/10.6709/TJD.201706_9(1).0003
   連結：
3. 林婉如、黃惠滿、李婷琳（2021）‧ 情緒困擾之概念分析‧高雄護理雜誌，38（1），50-61。https://doi.org/10.6692/KJN.202104_38(1).0005
   連結：
4. 姜亭妤、簡淑慧、徐鴻智、陳淑卿（2018）‧心理調節措施在癌症患者身體心像改變及情緒困擾之成效－系統性文獻回顧‧長庚護理，29（3），350-366。https://doi.org/10.6386/CGN.201809_29(3).0003
   連結：
5. Alanezi, H., Alshehri, A., Alrobiea A., & Yoo, M. W. (2019). The Causes, Prevention, and Management of Gastric Leakage after Laparoscopic Sleeve Gastrectomy: A Review Article. Journal of Metabolic and Bariatric Surgery, 8(2), 28-33. https://doi.org/10.17476/jmbs.2019.8. 2.28
   連結：
6. Bashah, M., Khidir, N., & El-Matbouly, M. (2020). Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution. Obesity surgery, 30(2), 515–520. https://doi.org/10.1007/s11695-019-04203-w
   連結：
7. Iossa, A., Abdelgawad, M., Watkins, B. M., Silecchia, G.(2016). Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbeck's Archives of Surgery, 401, 757-766. https://doi.org/10.1007/s00423-016-1464-6.
   連結：
8. Khalaj, A., Tasdighi, E., Hosseinpanah, F., Mahdavi, M., Valizadeh, M., Farahmand, E., Taheri, H., & Barzin, M. (2020). Two-year outcomes of sleeve gastrectomy versus gastric bypass: first report based on Tehran obesity treatment study (TOTS). BMC surgery, 20(1), 160. https://doi.org/10.1186/s12893-020-00819-3
   連結：
9. Romanzini, A. E., de-Carvalho, E. C., & Galvão, C. M. (2015). Delayed surgical recovery: a concept analysis. Revista brasileira de enfermagem, 68(5), 953-960. https://doi.org/10.1590/0034-7167.2015680526i
   連結：
10. Silecchia, G., & Iossa, A. (2018). Complications of staple line and anastomoses following laparoscopic bariatric surgery. Annals of gastroenterology, 31(1), 56–64. https://doi.org/10.20524/aog.2017.0201
    連結：
11. Wang, L., Tian, Z., & Liu,Y. (2017). Nasoenteric tube versus jejunostomy for enteral nutrition feeding following major upper gastrointestinal operations: a meta-analysis. Asia Pacific Journal of Clinical Nutrition, 26(1), 20-26. https://org.doi/ 10.6133/apjcn.112015.05
    連結：
12. Zhou, X., Yu, J., Li, L., Gloy, V. L., Nordmann, A., Tiboni, M., Li, Y., & Sun, X. (2016). Effects of Bariatric Surgery on Mortality, Cardiova-scular Events, and Cancer Outcomes in Obese Patients: Systematic Review and Meta-analysis. Obesity Surgery, 26(11), 2590-2601. https://doi.org/10.1007/s11695-016-2144-x
    連結：
13. 台灣外科醫學會（2023）‧合辦學會:台灣代謝及減重外科醫學會，減重代謝手術。https://www.surgery.org.tw/Surgery/file/%E5%90%88%E8%BE%A6%E5%AD%B8%E6%9C%83%E5%AE%A3%E5%82%B3112%E5%B9%B4%E6%9C%83_%E4%BB%A3%E8%AC%9D%E5%8F%8A%E6%B8%9B%E9%87%8D%E5%A4%96%E7%A7%91%E9%86%AB%E5%AD%B8%E6%9C%83.pdf
14. 周桂如、馮容芬（2017）‧與疾病有關的心理社會概念與理論‧於劉雪娥、王桂芸、馮容芬總校閱，新編內外科護理學（五版，4-53頁）‧永大。
15. 林口長庚紀念醫院(無日期)‧情緒檢測，簡式健康量表。https://www1.cgmh.org.tw/suicidelnk/%E6%83%85%E7%B7%92%E6%AA%A2%E6%B8%AC/%E6%83%85%E7%B7%92%E6%AA%A2%E6%B8%AC.html
16. 婁慈庭（2018）‧減重手術後，營養補給很重要‧彰基院訊，35（8），8-9。https://doi.org/ 10.29598/XLZY
17. 衛生福利部國民健康署（2023年，1月）‧成人肥胖防治實證指引。https://www.hpa.gov.tw/Pages/EBook.aspx?nodeid=1788
18. 台灣傷口造口及失禁護理學會（2015）‧空腸造瘻灌食與護理照護。https://www.twocna.org.tw/magazine/index_01info.asp?/133.html
19. World Health Organization(2020). Obesity and overweight. https:// www.who.int/news-room/fact-sheets/detail/obesity-and-overweight