一位心因性休克病人使用葉克膜之加護經驗

An Intensive Care Experience of a Cardiogenic Shock Patient on ECMO

本文旨在探討一位急性心肌梗塞（AMI）併發心因性休克的病人，於加護中心使用葉克膜（ECMO）維生系統的護理經驗。自2008年11月8日至11月19日護理期間，運用Gordon十一項功能性健康型態評估，透過實際照護、身體評估、觀察、會談等方式收集資料，確立個案有心輸出量減少、高危險性損傷、氣體交換障礙、焦慮等健康問題。筆者擬定個別性護理計畫：監測血液動力學變化並維護ECMO功能運作、預防出血及感染併發症、維持足夠氧合協助氣體交換、提供疾病認知與心理支持以減緩焦慮情緒，使個案順利脫離ECMO渡過疾病急性期而轉出加護病房。期許本篇報告的討論，能在專業領域中達到經驗分享。

This paper presented an acute myocardial infarction (AMI) patient complicated with cardiogenic shock with temporal use of ECMO life supporting system in ICU. While the patient was under the nursing care during the period of November 8th to 19th, 2008, we used Gordon’s 11 functional Health Patterns and established that the patient had health problems such as decreased cardiac output, high risk of organ damage, poor gas exchange and anxiety, etc. Guided by the review of literature, an individualized nursing care plan was formed to monitor the hemodynamic change, maintain the proper functioning of ECMO, prevent the complications of hemorrhage and infection, maintain proper oxygen and gas exchanges, and reduce the patient’s anxiety by adequate information and emotional support. This nursing care plan successfully weaned the patient from ECMO and the patient was transferred out of intensive care unit. We hope this report can share our experience with other professionals to further improve the nursing care for future patients with similar conditions.