一位主動脈剝離病患手術前後之護理經驗

Nursing Experience of Caring a Patient with Aortic dissection before and after Surgery

黃詠青(Yung-Ching Huang)；李彩緣(Chai-Yuan Lee)

主動脈剝離 ； 手術 ； 護理經驗 ； Aortic dissection ； Surgery ； Nursing Experience

若瑟醫護雜誌

9卷1期（2015 / 07 / 01）

107 - 120

繁體中文

本文在探討一位因升主動脈剝離病患手術前後之護理經驗。藉由觀察、筆談、手勢及病歷查閱方式收集資料，運用Gordon十一項功能性健康型態進行護理評估，確立個案有「組織灌流改變」、「急性疼痛」、「焦慮、」及「健康維護能力改變」護理問題。護理過程中，採集中護理、密切監測生命徵象並控制血壓，以確保有足夠的組織灌流；在疼痛方面，教導個案轉移注意力、支托傷口的技巧及胸骨固定帶使用並給予止痛藥物使用，以減緩疼痛；提供個案主動脈剝離手術相關完整的護理指導，由醫師說明疾病治療與處置、預後和相關注意事項，增強個案對疾病與手術的認知及恢復的信心，減輕焦慮；提供疾病、飲食衛教與教導調整生活飲食型態，強調規則服藥與戒菸的重要性，提升個案對疾病自我照顧、知識，預防疾病復發，為返家自我照護做準備。

The main purpose of this case report is to explore the experience of caring a patient with aortic dissection before and after surgery. Gordon's Functional Health Patterns were applied to assess the problems. The identified problems consisted of altered tissue perfusion, acute pain, anxiety, and changing of ability change of health promotion. During the nursing period, the patient was provided with centralized nursing care, closely monitoring of vital signs and control of blood pressure, in order to ensure a dequate tissue perfusion. The patient was also trained for skills to avoid wounds torn, distraction techniques and pain control was performed. Patient's anxiety was palliated by providing health education and the information of postoperative care. The education about disease, diet and adaptation of life and dietary pattern was provided with emphasizing the importance of regular medication and cigarette cessation and enhancing the knowledge on daily self-care, and eventually to prevent subsequent disease recurrence.

1. Eduardo, B.,Arturo, E.,Eric, I.(2007).Prognostic role of transesophageal echocardiography in acute type A aortic dissection.Am Heart J 2007,153,1013-1020.
2. Eggebrecht, H.,Nienaber, CA.,Neuhauser, M.(2006).Endovascular stent-graft placement in aortic dissection: A meta-analysis.Eur Heart J,27,489-498.
3. Gallagher, R.,McKinley, S.(2007).Stressors and anxiety in patients undergoing coronary artery By pass surgery.Cardiovascular Issues in Critical Care,16,248-257.
4. Gilmartin, J.,Wright, K.(2007).The nurse's role in day surgery: A literature review.International Nursing Review,54(2),183-190.
5. 甘宗本,林永發,車丕政(2006).急性升主動脈剝離症在區域醫院的手術治療結果.Acta Cardiologica Sinica,22,198-204.
6. 張忠毅(2009)。心血管急症：主動脈剝離。健康世界，281，40-44。
7. 陳錦康,楊世敦,源嘉鳳,謝旭滿(2008)。主動脈剝離多樣性臨床表徵。重症醫學雜誌，9，133-144。
8. 趙明玲,林雅慧,鄭如玉,林嘉玲,邢鴻君,余秋霖(2009)。手術衛教介入對改善脊椎手術病人焦慮之成效探討。輔仁醫學期刊，7，29-37。
9. 劉雪娥(2007).成人內外科護理學.台北:華杏出版公司.
10. 衛生福利部:民國，田年度死因統計。2014年06月16日取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=27

1. 陳碧君,邱雅凰(2022)。提高加護病房心臟手術病人術前護理指導完整率專案。領導護理，23(1)，115-129。
2. 陳逸霖,洪玉敏(2023)。一位創傷性主動脈剝離患者之護理經驗。新臺北護理期刊，25(2)，100-109。