照顧一對腹部連體嬰之手術全期護理經驗

Perioperative Nursing Experiences in Caring for Omphalopagus Conjoined Twins

本文是一對1歲1個月出生腹部相連連體嬰，出生後倆姐妹以肚子貼地學習爬行，入院行分割手術。護理自2015年2月10日至4月8日依五大整體性層面評估，並藉術前訪視上刀照護、術後會談、身體評估觀察及後續追蹤，確立問題有主要照顧者緊張，潛在危險性損傷，肢體活動不協調。照護期透過翻譯人員衛教手術訊息，以減緩主要照顧者緊張與焦慮，術前為倆姐妹量身訂製木馬坐椅推車，輔助活動學習坐穩；術中使用襪套、小兒專用脂肪墊保護頭部及骨突觸避免壓迫，分割手術後以手術帽顏色區分身份，接續並由兩組醫療團隊完成手術，手術後透過復健醫療團隊讓雙胞胎倆學習爬行，坐穩，站立走路並順利出院。期望藉由此篇個案報告照護經驗與臨床同仁分享。 This article concerns 13-month-old omphalopagus twins. They underwent separation surgery because they were incapable of resting on the belly and learning to crawl. The period of nursing care was from February 10th to April 8th, 2015. Five holistic nursing assessments were performed. Through preoperative visits, practical care, postoperative interviews, physical assessments, and follow-up, key problems were identified, which included main caregiver anxiety, potential risk of injury, and limb mobility restriction. Main caregiver anxiety can be relieved by providing an adequate translator. Tailored wooden horse carts for sitting and exercise were prepared. Some potential risks were avoided during surgery: socks and a special pediatric fat pad were used to protect the head and bones, surgical instruments were carefully aligned, and cloth was wrapped carefully around medical tubing. The twins were placed on separate operating tables, and operating caps of different colors were placed on the twins for identification. The separation surgery was performed by two independent medical teams. Postoperative rehabilitation included crawling, sitting, standing, and walking courses. The patients were discharged, having achieved an excellent outcome. It is hoped that through this case report, clinical experience can be disseminated and causes and effects can be clarified.