一位敗血症病童接受體外循環維生系統治療之加護護理經驗

The Nursing Care Experience of a Child with Sepsis and Extracorporeal Life Support in the Pediatric Intensive Care Unit

本文描述照顧一位先天免疫功能缺陷的三歲女童，感染肺炎雙球菌肺炎合併膿胸，出現敗血症候群，住加護病房接受目前鮮用於兒科的體外循環維生系統治療的護理經驗。91年3月25日至4月1日，筆者透過觀察、與父母會談、實際照護、身體評估等方式收集資料，運用Gordon十一項健康功能評估，確立病童有氣體交換障礙，感染，腎組織灌流改變，出血，營養少於身體需求及照顧者角色緊張等健康問題。在充分加重每班兩位的護理人力照顧下（一人負責機器的運轉順暢，筆者負責病童整體性照顧），積極嘗試體外循環維生系統治療來改善病童的呼吸衰竭，最終病童仍因先天免疫功能缺陷，引發多器官衰竭致喪失生命！不論病童生存與否，此艱澀的護理經驗，值得與護理同仁分享。

The purpose of this case report was to present the nursing care experience of a three-year-old girl who had congenital immunodeficiency, pneumococcus pneumonia with lung abscess and progressive septic syndrome that required Extracorporeal Life Support (ECLS) or Extracorporeal Membrane Oxygenation (ECMO) to support her life in the pediatric intensive care unit (PICU). During the period of care, data were collected through observation. Nursing assessment was based on the framework of Godern's functional evaluation. The major nursing Problems in clouded impaired gas exchange, infection , altered renal perfusion, bleeding, altered mutation with caregiver role strain on the progression of disease. Unfortunately, inspire of the intensive treatment by the medical-nursing team, the patient expired due to congenital immunodeficiencies with multiple organ failures; we therefore report the nursing experience of this particular case to share the role of nursing in the care of a critically ill child with respiratory failure necessitating ECMO therapy.