肝性腹水之治療及護理

Management and Nursing Care for Patients with Cirrhotic Ascites

腹水是肝硬化最常發生的合併症，大約有50％以上的肝硬化病患10年後會發生腹水，且當腹水形成時二年存活率約50％，根據行政院衛生署統計肝性疾病及肝硬化佔國人十大死亡原因的第六位。因為腹水造成腹壓增加，易導致疝氣及呼吸困難，也可能發生感染的問題，故對病患來說腹水不僅意味死亡的威脅也造成生理上的不適。針對腹水的治療包括臥床休息、低鈉飲食、利尿劑治療、腹腔放液術、腹膜靜脈分流術、經頸靜脈肝內門脈系統分流術及肝臟移植。針對肝性腹水病患可能因疾病本身及因治療而來的問題，護理人員應給予的護理措施包括鼓勵臥床休息、教導低鈉飲食的攝取、協助利尿劑的使用、維持呼吸道的通暢、維持皮膚的完整性、促進營養的攝取、預防感染的發生及維持體液電解質的平衡。

Ascites is a common complication of liver cirrhosis. Ascites develops after 10 years in up to 50% of patients with cirrhosis. When ascites develops in patient with cirrhosis, the 2-year survival rate is 50%. Liver disease and liver cirrhosis are the sixth leading cause of death in Taiwan. Because of the increased intra-abdominal pressure induced by ascites, patients may have problems of hernia, respiratory distress, and infection. Therefore, ascites not only causes physical discomfort but also is life-threatening. Management of ascites includes bed rest, low sodium diet, diuretics, paracentesis, peritoneovenous shunt, transjugular intrahepatic portal system stent, and liver transplantation. Nursing interventions include encouraging bed rest and low sodium diet, administering diuretics, maintaining airway clear, promoting adequate nutritional intake, preventing infection, and keeping fluid and electrolytes balance.