一位心因性休克病人使用體外膜氧合器之加護經驗

An Intensive Care Experience of a Cardiogenic Shock Patient on Extracorporeal Membrane Oxygenation

本文描述一位罹患急性心肌梗塞併發心因性休克患者，住加護病房接受體外膜氧合器治療的護理經驗。自2013 年1 月24 日至2 月15 日護理期間，運用羅氏適應模式為指引經由身體評估會談、觀察、傾聽及查閱病歷等技巧收集病史，確立個案有心輸出量減少、危險性感染、焦慮等健康問題，在照護期間有效運用護理過程密切觀察血液動力學數值之變化，維持穩定生命徵象並成功脫離體外膜氧合器。運用適當護理措施: 症狀護理、疾病相關衛教 主動適時的陪伴給予心理支持。並運用急性心肌梗塞和體外膜氧合器之學理為依據，配合醫囑給藥物和治療，解除個案身心不適之症狀。期許本篇報告討論，能專業領域中達到經驗分享。

This paper described the nursing experience of caring an acute myocardial infarction patient complicated with cardiogenic shock with temporal use of extracorporeal membrane oxygenation life supporting system in an ICU. The patient was under the nursing care during the period of January 24th to February 15th, 2013. Data on medical history where collected by interview, observation, listening, and medical record review and evaluated according to Roy’s adaptation model assessment tool. The main health problems included decreased cardiac output, high risk for infection, and anxiety. With the help of effective nursing process, close monitoring of hemodynamic state and maintaining the vital sign stable, the patient passed the critical stage and weaned from extracorporeal membrane oxygenation support successfully. Adequate nursing care included symptoms care, disease-relate health education, timely and initiative ompanionship for patient, and psychological support. Appropriate nursing management according to medical prescription and the standard scientific principle of extracorporeal membrane oxygenation for acute myocardial infarction were offered. We hope this report can share our experience with other professionals to further improve the nursing care for further patients with similar condition.