一位上腸繫膜動脈症候群青少女的護理經驗

Nursing Experience Caring for a Female Teenager With Superior Mesenteric Artery Syndrome

上腸繫膜動脈症候群，好發於青少女，是一種少見且具致命性的疾病，主要因過瘦導致主動脈與上腸繫膜動脈之間脂肪不足，以致主動脈與上腸繫膜動脈夾角壓迫通過其間的十二指腸第三部份，造成腸阻塞症狀。支持性治療的目的是增加體重，增加上腸繫膜動脈與腹主動脈間的角度。本個案為一位體位過輕的14歲青少女，因反覆出現的劇烈嘔吐與腹脹症狀，甚至必需因病考慮休學，造成個案出現情緒激動，抗拒治療與護理介入的焦慮情況。照護期間自2017年8月14日至8月30日，發現個案有營養不均衡及焦慮的護理問題，護理聚焦在改善營養包括：（1）增進營養狀態，（2）促進舒適及（3）維持熱量攝入。降低焦慮則包括：（1）增加自我控制感，（2）提供參與治療計畫的機會及（3）轉移注意力體認自我價值。最終個案體重增加，使得上腸繫膜動脈與腹主動脈夾角亦隨之增加，症狀緩解，焦慮減輕。藉此次護理經驗以提供日後護理人員臨床照護類似個案之參考。

Superior mesenteric artery syndrome (SMAS) is a rare and life-threatening disease that affects women more frequently than men. SMAS is characterized by extensive compression of the 3rd part of the duodenum between the aorta and the superior mesenteric artery. This compression results in chronic, intermittent or acute obstruction of the small bowel due mainly to the lack of fat between the aorta and the superior mesenteric artery, which increases the angle between the aorta and superior mesenteric artery and the end of the duodenum, causing intestinal obstruction. The goal of supportive treatment is to increase both body weight and the angle between the mesenteric artery and the abdominal aorta. This case involved a 14-year-old girl with low body weight who suffered from SMAS. Her symptoms included recurrent, severe vomiting and bloating, which necessitated her taking time off from school, causing further anxiety and leading to agitation, resistance to further treatment and care, and moresevere symptoms. During the period of nursing care from August 14th to August 30th, 2017, the author identified symptoms of nutritional imbalance and anxiety. Care initiated to improve nutritional status included: (1) improving nutritional intake, (2) promoting comfort, and (3) maintaining caloric intake. Care initiated to reduce anxiety included: (1) increasing self-control, (2) providing opportunities to participate in treatment planning, and (3) refocusing attention on self-worth. At the end of care, the patient had gained weight, the angle between the upper mesenteric artery and the abdominal aorta had increased, the symptoms had subsided, and anxiety had been alleviated. This nursing experience offers a reference for nurses facing similar cases of clinical care.