心跳停止復甦後目標體溫控制治療之重症照護實務與應用

Critical Care Nursing in Targeted Temperature Management (TTM) After Cardiac Arrest

目標體溫控制管理（targeted temperature management）是一複雜且精細的重症照護措施，目前已被美國心臟學會列為治療指引中重要的處置，並廣泛被運用在心跳停止復甦後未甦醒病人，其目的在降低心跳停止復甦後再灌流所造成的腦損傷及改善神經學功能預後。照護療程可分為誘導降溫期、維持期、回溫期及常溫期。照護期間需遵守「快降緩升」原則進行體溫微控，也需維持體溫穩定減少變動，並嚴密監控各期核心體溫變化下所帶來的生理改變及預防與治療可能的併發症，如寒顫、高低血糖、異常電解質、皮膚損傷、心律不整、及感染等。本文參考相關文獻並結合臨床實務經驗，針對重症護理師在照護心跳停止復甦後病人接受目標溫控治療時，各分期之實際作法與照護重點及注意事項做一彙總及說明。期望能提供重症護理人員在照護目標溫控病人時之參考，以提升病人安全與照護品質。

Targeted temperature management (TTM) is a complex and sophisticated intensive-care procedure that is included in the American Heart Association guidelines for treating patients who remain unconscious after resuscitation from cardiac arrest. TTM has been demonstrated to reduce brain injury associated with reperfusion after resuscitation and to improve the neurological prognosis in patients with cardiac arrest. The TTM process may be divided into four phases: induction, maintenance, rewarming, and normothermia. The critical element in TTM is the quick lowering and slow raising of body temperature, which should be fine-tuned to maintain temperature stability and minimize variation. Caregivers should monitor the physiological changes caused by core body temperature change closely and manage possible complications such as shivering, hypo- and hyper-glycemia, electrolyte imbalance, skin injury, arrhythmia, and infection. Based on contemporary evidence and clinical experience, this article provides critical care nurses a summary and key points of each stage of TTM when used to take care of resuscitated patients after cardiac arrest. We hope this work may help improve patient safety and quality of care during the TTM procedure.