一位脊椎腫瘤切除術病人之手術全期護理

Perioperative Nursing of a Patient Undergoing Spinal Tumor Resection

當病人面臨脊椎腫瘤手術時生理及心理都承受極大的壓力，如何使病人安全、又安心的渡過手術全期，對身為手術室護理師是應盡的責任，故引發選案理由。本文主要探討一位行脊椎腫瘤切除術病人之手術前、中、後期的護理經驗。護理期間為2018年2月25日至2018年3月2日，運用手術全期護理及Gordon十一項健康功能評估，確立病人的健康問題有焦慮、潛在危險性傷害及疼痛等。在護理過程中針對病人個別性的需求，如對手術室陌生環境的害怕和擔心預後及腫瘤是否為良性，於術前提供手術室環境、手術過程介紹及術後管路照顧和手術預後資訊給病人，以減少焦慮；於手術過程中，給予正確的姿勢擺位，並提供安全的手術環境，避免手術傷害和預防術後感染；術後減輕病人疼痛，增加舒適感等，協助病人安心的渡過手術過程。藉由此次手術全期護理經驗，建議善用術前訪視時間，評估處理病人個別化的問題，達到手術全期的照護。此文除了提昇個人的照護能力外，也能提供更多手術室護理師一個完整的手術全期照護參考。（澄清醫護管理雜誌2022；18（1）：60-69）

"Purposes:To explore the correlation between utilization of medical resources and survival rate in lymphoma patients with different demographic characteristics, disease characteristics, and treatment approaches.Methods:This was a retrospective study. The data sources on lymphoma patients from 2006 to 2013 were as follows: 1. A review of medical records by collecting the demographic characteristics, disease characteristics, medical treatment, and other relevant data; 2. Pathology reports; 3. Details of hospitalization expenses and outpatient medical expenses submitted to the National Health Insurance Administration by the information office. The data were analyzed with SPSS Version 20.0. Descriptive statistics were applied for the analysis of each variable. One-way ANOVA and linear regression analysis were conducted for medical resource utilization. Kaplan-Meier survival rate was adopted to analyze the survival rate.Results:ith family, patient’s albumin level, Hepatitis B carriers, patients who used a targeted drug, and those who received chemotherapy had a higher utilization rate of medical resources. The five-year overall survival rate was up to 60%, and the survival rate in females was significantly higher than that in males. LDH andβ2-microglobulin affected the survival of lymphoma patients.Conclusions:Demographic and disease characteristics as well as treatment approaches are the factors that influence the utilization of medical resources. The principle of lymphoma treatment is to consider the disease characteristics and health status, and intervention by targeted drugs can improve the survival rate. This study enrolled cases in a single medical center, which can be combined with cancer databases in the future to mutually confirm the utilization of medical resources. (Cheng Ching Medical Journal 2022; 18(1): 60-69)"