急性食道穿孔之臨床治療與護理

Clinical Treatment and Nursing Cares for Patients with Acute Esophageal Perforation

食道具運送食物與防止逆流的功能。當食道穿孔，會造成周圍組織損傷，整體營養功能下降，進而出現縱膈腔炎、心包填塞或死亡。急性食道穿孔的臨床表徵取決於導因、損傷大小與位置，患者會出現疼痛、發燒、呼吸喘、皮下氣腫等症狀。急性食道穿孔須經由X光、電腦斷層、或顯影劑攝影及臨床表徵來鑑別診斷。臨床治療需根據致病導因與穿孔區段，選擇合適的醫療處置，多採藥物治療為主，如抗生素，合併內視鏡治療或外科手術，如食道支架、止血夾、食道切除手術、食道分流手術、穿孔修護手術及引流系統。護理照護重點首重營養支持，盡早建立腸道營養，亦可透由完整身體評估、感染控制、護理指導及出院照護，以預防敗血症、呼吸衰竭、或併發症，以提供患者個別性全人照護。在臺灣，由於相關文獻及研究仍欠缺，本文探討急性食道穿孔之鑑別診斷、臨床治療適應症與護理，期望能提供臨床醫護人員照護此類患者之參考依據。

The functions of esophagus are to deliver food and prevent backflow. When esophageal perforation occurs, it will cause damage to the surrounding tissue, decrease of overall nutritional status, then re-sulting in mediastinum inflammation, cardiac tamponade or death. The clinical presentations of acute esophageal perforation depend on its etiology, lesion size and location. Patients might have pain, fever, dyspnea, and emphysema. Acute esophageal perforation should be diagnosed with X-ray, computed tomography, or enhanced esophagography and clinical presentations. The selections of treatments for acute esophageal perforation should be based on its etiology and location. The primary treatments are medications s such as antibiotics together with endoscopic therapy or surgery, such as esophageal stents, hemostatic clips, esophageal local resection surgery, esophageal bypass surgery, perforation repair surgery, and transgastric drainage. Nutritional support should be the primary focus of nursing care and the enteral nutrition should be established as soon as possible. Nurses can provide individual-ized holistic care through comprehensive physical assessment, infection control, health education, and discharge-care plans in preventing sepsis, respiratory failure, or other complications. This article re-viewed the differential diagnosis, medical treatment indications, and nursing care of acute esophageal perforation. Due to limited literatures and previous studies available in acute esophageal perforation, this article may sever as a reference for clinicians in caring for this group of patients.