到院前心跳停止復甦後病人使用低溫治療之加護經驗

Out-of-Hospital Cardiac Arrest Patient Using Therapeutic Hypothermia: An ICU Nursing Experience

本文旨在描述一位到院前心跳停止經急救復甦恢復自發性循環病人，於急診加護病房接受低溫治療及經皮冠狀動脈氣球擴張術之護理經驗。2013年6月9日至6月18日護理期間，運用Gordon’s十一項功能性健康型態為評估架構，以觀察、會談、身體評估及跨團隊討論等方式收集資料，確立個案有體溫過低、氣體交換障礙、心輸出量減少與焦慮等健康問題。在低溫治療護理過程中，筆者嚴防各項生理變化引發合併症造成之損傷；並謹慎評估組織缺氧徵象維持足夠氧合以改善其氣體交換障礙問題。行經皮冠狀動脈氣球擴張術期間，密切監測心臟灌流功能與降低心肌負荷以減少心輸出量。運用關懷及同理心傾聽個案需求，予個別護理指導，說明疾病與手術之相關知識及心理支持，以減輕個案因受到生命威脅所引發之焦慮。同時訂定完整出院計畫，協助個案順利回歸社區生活。期望此次罕見之實務經驗，能提升同儕於急救復甦後的專業護理品質。

This paper described the nursing experience of using therapeutic hypothermia and percutaneous transluminal coronary angioplasty (PTCA) in an emergency intensive treatment for an out-of-hospital cardiac arrest patient after the return of spontaneous circulation (ROSC). During the caring period (06/09/2013–06/18/2013), Gordon’s 11 item functional health patterns were applied as the assessment framework. Data were collected using observations, interviews, and physical assessments, and multidisciplinary team discussions were conducted to confirm the health problems (i.e., hypothermia, impaired gas exchange, decreased cardiac output, and anxiety). When employing therapeutic hypothermia, the author rigorously prevented the complications caused by physiological changes, cautiously assessed the signs of hypoxia, and maintained sufficient oxygenation to alleviate impaired gas exchange. During PTCA, the cardiac perfusion function was closely monitored and the myocardial load was decreased to reduce the cardiac output. The author empathetically listened to the patient, provided guidance and psychological support and offer information related to the disease and surgical operations to alleviate the patient’s anxieties. In addition, comprehensive discharge planning was provided to facilitate the return of the patient to regular life. This rare but practical experience improve the quality of professional care following a post emergency resuscitation.