一位肝臟撕裂傷患麻醉期間發生惡性高溫之護理經驗

The Nursing Experience of a Liver Laceration Surgery Patient who Suffered from Malignant Hyperthermia during General Anesthesia

本文描述一位車禍肝臟嚴重撕裂傷青少年，短期內再次行剖腹探查手術時於麻醉期間發生惡性高溫，術後入住加護病房之護理經驗。筆者以麻醉科護理師的角色於2008年11月13日至11月25日協同照護個案，發現個案有呼吸道清除功能失效、體溫過高、疼痛及焦慮等健康問題。護理過程中運用同理心透過關懷、傾聽、陪伴與個案建立良好治療性關係，鼓勵個案以正向態度面對此特異體質(idiosyncrasy)，並引導其抒發負向情緒感受，同時加強病人與家屬對惡性高溫的了解及提醒其未來必須注意事項。經過近二星期的照護，個案呼吸、體溫等生理現象均回復正常，疼痛及焦慮獲得緩解，身、心、社會各方面逐漸適應。希望此文提供護理同仁瞭解惡性高溫照護之參考。

This case report describes the nursing experience of a teenager who was injured in a car accident. He suffered from malignant hyperthermia during general anesthesia period when accepting the second exploratory laparotomy surgery and then transferred to the ICU after the operation. The author, who was an anesthetic nurse, coordinated with an ICU nurse to look after this case from Nov. 13th to 25th, 2008. The patient had ineffective airway clearance, hyperthermia, acute pain, and anxiety. Therefore, the author has established therapeutical relationship with the patient through empathy, concern, and listening, accompanying with the patient during the nursing process. Furthermore, the author encouraged the patient to face idiosyncrasy, led him to express the negative emotion, offered professional knowledge about malignant hyperthermia. After two weeks, the patient’s breathing and body temperature has returned to a normal range, acute pain and anxiety had been released. Physical, psychological and social ability were eventually adapted. It is hoped that this report can provide nursing profession with experiences of caring malignant hyperthermia patients.