照顧一位雙胞胎輸血症候群孕婦行胎兒內視鏡之手術全期護理

Fetal Endoscopy Perioperative Nursing Care for a Twin Pregnancy Woman with Twin-Twin Transfusion Syndrome

本文描述一位38歲雙胞胎妊娠婦女，於妊娠18週時診斷為雙胞胎輸血症候群，接受胎兒內視鏡手術之護理經驗。照護期間為2016年9月11日至9月20日，手術前、中、後期藉由訪談、觀察及傾聽等技巧，應用Orem理論及手術全期護理理論收集資料及確立問題。照護過程中發現有：焦慮、潛在危險性手術情境的傷害、潛在性危險性感染與傷口疼痛問題。筆者應用Orem理論於術前訪視時，提供個案相關諮詢、教育及支持性的護理措施，增加個案對胎兒內視鏡手術與手術環境的認知，以緩解焦慮情緒；術中個案因採半身麻醉失去部分自我照顧能力，給予部分代償性護理措施，以預防手術臥位、內視鏡與雷射儀器的使用，而造成潛在危險性手術情境的傷害，並提供無菌的手術環境與相關措施以避免感染問題發生；術後自我照顧能力恢復期間，提供支持與教育性護理，降低傷口疼痛。期望藉由手術護理協助個案渡過此次手術，且能提供手術室護理人員照護此類病人之參考。

This report describes the perioperative nursing experience with a 38-year-old woman of twin pregnancy. In the 18th week of her gestation, she was diagnosed with Twin-Twin Transfusion Syndrome (TTTS) when undergoing fetal endoscopic surgical care. The care period was from September 11th to 20th of 2016. The researcher used Orem's self-care patterns as a theoretical framework for assessing the patient's needs in physical, mental, and social health. During the preoperative period, the patient's biggest health concerns included anxiety, the potential risks for injury and risk of infection during the intraoperative phase, and the pain during the postoperative phase. In this period, nursing care covered empathetic listening, concept teaching, and support for the purpose of promoting case awareness of the fetal endoscopic surgery and surgical environment so as to relieve the patient's anxiety. Moreover, during the operation, half-closed anesthesia caused the patient to lose some self-care ability, she was provided with some compensatory care measures to prevent potentially dangerous surgical situations resulted from the use of surgical lying position, endoscopy, and laser equipment and to provide aseptic surgical environment as well as related measures for avoiding any possible infection. In addition, during the period when the patient's cared for herself for post-surgical recovery, she was provided with support and educational care to reduce wound pain. It is hoped that this medical operation can be facilitated through surgical nursing, and this case study will provide reference for operating room nurses to care for such patients.