談巴金森氏病患者行深部腦刺激術的護理

Nursing Care of Deep Brain Stimulation in Patients with Parkinson’s Disease

巴金森氏病是一種慢性、神經退化性疾病，其主要症狀特徵為顫抖、僵硬、運動遲緩及步態不穩。這些症狀一開始對藥物levodopa(L-dopa)治療非常有效，但假以時日，當病情更嚴重時，患者對藥量之需求顯著增加，藥效變短及因藥物的副作用如：無法預期之“開”“關”交替反應現象、異動症等亦伴隨而來。此時，醫師可能會建議採取神經外科治療，尤其是深部腦刺激術。為達到手術最大效益，醫護的團隊合作是很重要的，護理人員應對手術過程及術後可能產生的成效有清楚的瞭解，才能協助醫師與患者溝通及提供最合適的術前與術後護理措施。

Parkinson’s disease (PD) is a chronic neuro-degenerative disorder and it is characterized by tremors, rigidity, bradykinesia, and postural instability. These cardinal symptoms improve with medication such a levo-dopa (L-dopa). However, over time, as the disease progress, the patient reveals the increase to the dose demand and shortening to the drug efficacy and becomes refractory to medication or medication produces debilitating side effect, such as not anticipated “on” and “off” phenomenon. When this occurs, neurosurgical treatment is recommended, particularly deep brain stimulation. To achieve maximum beneficial effects with minimum adverse effects from the surgery, the expertise of an integrated team of physicians and nurses is essential. The nurses must have a clear understanding of the different aspects of the surgical procedure, including the benefits of the treatment, assist neurosurgical physicians in communicating with the PD patient, and provide the most appropriate pre-and postoperative care.