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| 題 名 | 一位初次行側胸冠狀動脈繞道手術個案之加護經驗=Intensive Care Experience of a Patient Undergoing Lateral Thoracotomy Coronary Artery Bypass Surgery for the First Time |
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| 作 者 | 林香君; 林靖芸; | 書刊名 | 領導護理 |
| 卷 期 | 26:3 2025.09[民114.09] |
| 頁 次 | 頁38-53 |
| 分類號 | 419.821 |
| 關鍵詞 | 冠狀動脈繞道手術; 氣體交換障礙; 疼痛; 焦慮; Coronary artery bypass surgery; Gas exchange disorder; Pain; Anxiety; |
| 語 文 | 中文(Chinese) |
| DOI | 10.29494/LN.202509_26(3).0004 |
| 中文摘要 | 根據衛生福利部資料,心臟疾病高居國人十大死因第二名,標準化死亡率47.8人/每十萬人口,心臟疾病急性猝死中,以冠狀動脈疾病為最多。本文探討一位側胸冠狀動脈繞道手術之個案,因活動時呼吸喘,行心肌灌流掃描發現心肌缺血,安排心導管檢查,顯示冠狀動脈三條血管阻塞,預行側胸冠狀動脈繞道手術入院。術後入加護病房,因陌生環境感到焦慮不安,脫離呼吸器後又因傷口疼痛降低執行心肺復健意願,致血氧濃度下降,若持續惡化則需再次插管,故引發筆者書寫動機。照護期間為2023年11月16日至11月23日,藉由直接照護、觀察、會談、身體評估及病歷查閱,以Gordon十一項功能性健康評估作為護理評估指引,進行資料收集、分析整理。發現有氣體交換障礙/與肺泡通氣不足有關、疼痛/與手術傷口所致有關、焦慮/與擔心術後復原狀況不如期待有關等三項主要健康問題。照護期間依據疼痛評估調整止痛藥物及家屬協助精油按摩、聽音樂及看影片轉移注意力,偕同呼吸治療師及復健師擬定心臟復健計畫,運用Triflow呼吸訓練器,增進心肺功能與肺泡擴張,提供疾病資訊,教導自我照護能力,緩解焦慮感受,盼藉此案例之分享,提供護理人員照護參考。 |
| 英文摘要 | According to Ministry of Health and Welfare data, heart disease ranks second among the top ten leading causes of death in Taiwan, with a mortality rate of 47.8% per 100,000 population. Coronary artery disease is the most common cause of sudden cardiac death. This study examines a patient who underwent coronary artery bypass surgery after feeling shortness of breath while exercising. A myocardial perfusion scan revealed the presence of myocardial ischemia, and cardiac catheterization indicated a triple occlusion of the coronary arteries. The patient was hospitalized to undergo coronary artery bypass surgery and was transferred to the intensive care unit afterward. The patient had a low desire to complete cardiopulmonary rehabilitation due to the anxiety of staying in an unfamiliar environment and distressed with wound pain after weaning from mechanical ventilation. Consequently, the patient's blood oxygen levels dropped, and re-catheterization was required if the condition worsened. The author thus was inspired to conduct this study based on this case experience. Care period was from November 16 to 23, 2023. An assessment framework depend on Gordon's 11 Functional Health Patterns was applied, data was collected, consolidated, and analyzed through direct nursing care, observations, interviews, physical assessments, and medical record researching. Three primary health problems of the patient were identified, include impaired gas exchange associated with alveolar hypoventilation, postoperative wound pain, and anxiety arising from the fear of poor postoperative recovery. During the period of caring, the analgesic dosage was adjusted based on pain assessments, and the patient's attention was diverted by providing essential oil massages assisted by the patient's family members and encouraging the patient to listen to music and watch videos. A cardiopulmonary rehabilitation plan was devised together with respiratory and rehabilitation therapists, using the Triflow breathing exerciser to improve cardiopulmonary function and intensify atelectasis. The patient was also educated regarding to their illness and equipped with self-care skills to reduce their anxiety. Hopefully, this nursing care experience can be served as a reference for nurses to provide care to similar patients in the future. |
本系統中英文摘要資訊取自各篇刊載內容。