照護一位先天性乳糜胸早產兒之護理經驗

Nursing Experience of a Premature Infant with Congenital Chylothorax

10.6740/NTUHJN.202401_20(1).0012

林鈺瑋(Yu-Wei Lin)；范圭玲(Guei-Ling Fann)；陳玉蓮(Yu-Lien Chen)

先天性乳糜胸 ； 早產兒 ； 營養少於身體所需 ； 以家庭為中心 ； Congenital chylothorax ； premature infants ； decreased nutrition intake ； family-centered model

臺大護理雜誌

20卷1期（2024 / 01 / 01）

126 - 137

繁體中文;英文

本文描述照護一位先天性乳糜胸早產兒之護理經驗，護理期間為2021年4月13日至6月23日，個案出生後因先天性乳糜胸反覆積液影響其生命徵象加上長時間未進食下導致營養狀況不佳，藉由系統性身體評估、臨床實際照護及與家屬會談等方式，進行主客觀資料的收集，確立其健康問題為：氣體交換障礙、營養少於身體所需及照顧者角色緊張。照護期間以家庭為中心，提供個別化護理措施：（一）協助胸腔穿刺及監測胸腔引流量，提供適當擺位以維持良好的氧合循環；（二）醫療團隊與營養師共同討論選擇高熱量、含豐富中鏈脂肪酸之特殊配方奶Enfaport進行餵食；（三）主動告知個案病情及治療方向，發揮同理心給予情緒支持，鼓勵並協助案父母參與個案照護活動，建立良好親子依附關係，以增進返家後照護之信心。因臨床中此為特殊少見案例，建議單位製作此疾病知識及營養照護之衛教單張或二維碼閱讀器，除了可提升護理品質，亦讓家屬瞭解相關知識以降低內心的焦慮不安。希望藉此個案照護經驗之整理及分享，提供臨床醫療人員日後在照護相似案例之參考。

This article describes the nursing care of a premature infant with congenital chylothorax. The nursing period was from April 13 to June 23, 2021. The patient's vital signs were unstable owing to recurrent lymphatic fluid accumulation in the congenital chylothorax after birth, and prolonged fasting resulted in malnutrition. Data were collected through systematic physical examination, clinical care, and interviews with parents, which revealed three major problems: (1) impaired gas exchange, (2) decreased nutritional intake, and (3) caregiver role strain. Individualized nursing care was provided, including assistance with thoracentesis, monitoring the amount of chest drainage, proper positioning to provide good oxygenation circulation, and choice of high-calorie and medium-chain fatty acid formula milk. The family centered model was applied to support their emotions and encouraged parents to participate in the infant's daily care to promote a healthy parent-child bond and increase their confidence in caring for their child after discharge. It is recommended to create health information leaflets or QR code readers on the knowledge or nutritional care of this rare case's disease to reduce parents' anxiety and promote quality of care. This experience serves as a reference and provides clinicians with an enhanced understanding of congenital chylothorax.