發炎性腸疾病之臨床處置與照護

Clinical Management and Nursing Care of Patients with Inflammatory Bowel Diseases

發炎性腸疾病（潰瘍性結腸炎及克隆氏症）常引發血便、腹痛、腹瀉、發燒等症狀，且易併發腸阻塞、腹內膿瘍、腸穿孔等合併症，臨床上多採內科治療，如抗發炎藥物、類固醇及抗腫瘤壞死因子藥物，外科手術亦用於治療併發症。此病致病機轉至今不明，無法治癒且長期腸胃道反覆發炎反應造成患者焦慮、不安、憂鬱、疲憊、生活品質不佳及工作受干擾，由於國內相關研究不足，其發生率逐年上升且國內標準死亡比高於全世界，故綜整相關文獻以利臨床醫護人員參考。結果發現，此病與基因、環境暴露、腸道菌叢及免疫力有關，益生菌、益生素、合益素或腸道營養素等緩和治療被用來維持腸道菌種平衡及營養支持，情緒、壓力管理與按時服用藥物也可減少發炎反應、避免疾病復發及合併症產生。本文可協助醫護人員了解發炎性腸疾病臨床鑑別、致病因子、醫療處置及護理照護，以提升病人照護品質，降低疾病復發率。但護理相關實證研究仍不足，期能有更多護理實證研究以支持此類病人之照護依據及指引。

Inflammatory bowel diseases that includes ulcerative colitis and Crohn’s disease cause the symptoms of bloody stool, abdominal pain, diarrhea and fever. These conditions can result in severe complica-tions such as intestinal obstruction, intra-abdominal abscess, and intestinal perforation. The anti-in-flammatory medication, corticosteroid and anti-TNF agents are initially chosen as the conservative treatment in clinical practices. The surgical interventions may also be used to treat the complications. The etiologies of inflammatory bowel diseases are still not fully understood. The incurable, long-term and recurrent gastrointestinal inflammation can cause anxiety, worries, depression, fatigue, poor qual-ity of life and work interruptions in patients with these conditions. The incidence rate of inflammatory bowel diseases increases each year and the standardized mortality ratio of inflammatory bowel diseas-es in Taiwan is higher than the global one. Additionally, there are few domestic research in this area. Therefore, a comprehensive literature was reviewed in this article to inform clinical practice. The results showed that the genes, environment exposure, gut microbiota, and intestinal immune response are related to inflammatory bowel diseases. Palliative cares, such as probiotics, prebiotics, synbiot-ics, or enteral nutrition, are used to maintain intestinal balance for reducing bowel inflammation and provide nutritional support. Moreover, mood and stress management, and regular medication are con-sidered as effective strategies to reduce recurrence, inflammatory response, and complications. This article can help medical staffs and nurses to understand the types, differential diagnosis, pathogenesis, medical management, and nursing care of inflammatory bowel diseases in order to improve the quality of clinical management and reduce the relapse rate. However, we suggest that more nursing empirical research is needed to provide evidence-based care and guidelines in this field.