一位950公克極低體重早產兒併發呼吸窘迫之加護經驗

An Intensive Care Experience of a 950 gm Extreme Low Body Weight Prematurity Complicated with Respiratory Distress

本文旨在描述一位妊娠26+1週出生體重950公克之極低體重早產兒，因呼吸窘迫於新生兒加護病房之護理經驗。自2010年8月4日至12月2日護理期間，運用系統性觀察進行個案生理、行為變化、環境和家庭評估，確立個案有氣體交換障礙、無效性保護能力、低效性嬰兒哺餵型態、混亂性嬰兒行為、潛在危險性父母/嬰兒依附關係改變等護理問題。筆者擬定個別性護理：維持通氣穩定促進氧合功能，監測凝血機制與預防出血，施行口腔動作發展訓練促進吸吮協調，減少環境過多刺激促進自我統整行為，施行寧握護理與教導袋鼠式護理以增進親子情感連結，並與家庭成員共同訂定出院照護計畫，使個案獲得完整性、持續性的護理。期許本篇報告的護理經驗，能在早產兒整體性照護中達到經驗分享。

This article reported the intensive care experience of an extreme low body weight premature baby of 950 grams and a gestation age of 26+1 weeks complicated with respiratory distress. During the period of August 4 to December 2 of 2010, we assessed the physiology, the behavior, the environment, and the family of the case by systemic observation and established the nursing care problems of impaired gas exchange, ineffective protection, inefficient infant feeding pattern, disorganized infant behavior, and risk for impaired parent/infant attachment. The authors provided a nursing care plan for the patient, including maintaining the ventilation to stabilize the gas exchange, monitoring the function of coagulation to prevent bleeding, training the motion of mouth to promote coordination of sucking and swallowing, decreasing the hyper-stimulation of environment to intensify behavior of self-integration, performing containment, and educating the family members about kangaroo care to improve the bonding between the baby and parents. We also discussed with the family to establish a discharge care plan to ensure continuous nursing care. We expected that we could share this experience of integrative nursing care of extreme low weight prematurity.