A型主動脈剝離術後合併腔室症候群患者之照護經驗

Nursing experience of a patient with compartment syndrome after aortic dissection type A operation

本篇敘述一位成年男性被診斷急性A型主動脈剝離，接受全主動脈弓置換手術後右小腿合併腔室症候群，於加護病房的照護經驗。照護期間為2019年2月16日至2月28日，藉由病歷查閱、觀察、會談及傾聽技巧等方式進行資料收集，歸納分析個案有術後急性疼痛、呼吸道清除功能失效及焦慮等健康問題，提供個別性護理措施如聽流行音樂及播放個案所喜歡的漫威系列電影，以轉移對疼痛注意力；教導正確咳嗽技巧、拍痰機使用及配合復健運動計畫，以增加肺擴張及促進痰液排出；增加個案對於疾病及預後的了解，降低個案焦慮程度。照護過程中發現利用手機，每日拍下傷口外觀並上傳電子病歷，不僅讓醫療照護團隊有共同的溝通平台以監測傷口變化，更能分享給個案及家屬了解傷口復原狀況進而共同參與照護。故建議未來照護此類個案可適當運用3C產品，拉近與年輕族群的距離也讓個案參與照護。

This article describes the nursing experience with a male who was diagnosed with acute type A aortic dissection, underwent total aortic arch replacement surgery and was attended to in the intensive care unit after suffering from the complications of the right calf compartment syndrome. The nursing period is from February 16th to February 28th, 2019. Data collection is conducted through medical record review, observation, interview, and listening skills. The cases are summarized and analyzed for postoperative acute pain, respiratory tract clearance failure, anxiety and other health problems. By providing individual nursing measures such as listening to popular music and playing Marvel movies that the case likes, it helps the case to divert attention from pain; Moreover, we taught the case cough skills and the use of sputum shooting machines; also, we made a rehabilitation exercise plan to increase lung expansion and promote sputum discharge. By means of the nursing measurement mentioned above, the case increasingly understood the disease and prognosis, which helped reduce the case´s anxiety. During the care, it was discovered that taking pictures of the wounds with mobile phones and uploading medical record every day not only allowed the medical care team to monitor wound changes but also helped the patient and his family to understand the wound recovery status and furthermore participate the caring process. We strongly recommend that electronic devices be used appropriately in caring for such cases in the future to narrow the distance between young people and make patients more involved in the care.