一位頸椎前位手術後併發致命性咽後血腫病人的護理經驗

Nursing Experience of Caring a Patient with A Fatal Retro-Pharyngeal Hematoma Post Anterior Cervical Spine Surgery

本文探討一位18歲青少年病人，因車禍造成高位頸椎骨折術後併發致命性咽後血腫並接受非預期二次手術。個案突然面臨傷口腫脹疼痛、痰液鬱積吸不到氣，在未知的情境感受面臨死亡等情況，從2021年6月19日至7月3日照顧期間，透過會談、陪伴、傾聽、直接照顧及查閱病歷等方式收集資料，運用羅氏適應模式評估，發現病人依序有急性疼痛、呼吸道清除功能失效及死亡焦慮等健康問題。照護過程醫療團隊運用疼痛控制技巧，教導避免使用Valsalva運動，期能在最小副作用下取得最大疼痛緩解；配合噴霧及肺部物理治療排出痰液，提供頸圈使用方式以維持脊柱位置避免骨釘脫落，讓個案盡早恢復獨立自我照顧生活；瞭解病人對疾病有無力感的恐慌及接近死亡的感受與想法，依照病人的喜好提供舒適的措施，尊重病人的信仰和提供專業的靈性照顧減輕焦慮。透過個別性護理及給予疾病照護資訊，促使家屬與病人共同參與治療計畫，出院前轉介出院準備透過社工協助提供福利資源，於回診時適時追蹤訪談，以達到持續性的全程照護。期望藉此個案照護經驗分享，提供臨床照護之應用。

This report describes the nursing experience of caring for an 18-year-old adolescent patient who suffered a high cervical fracture in a car accident, complicated by a fatal pharyngeal hematoma and unexpected secondary operation. From June 19 to July 3, 2021, the patient experienced sudden painful swelling of the wound, difficulty breathing due to sputum accumulation, and feelings of fear and powerlessness. Roy's Adaptation Model was applied to the care plan, which included pain management techniques, such as instructing the patient to avoid the Valsalva maneuver, to achieve maximum pain relief with minimal side effects. The patient was also provided with a neck collar to maintain spinal alignment and prevent dislodgement of the bone screw, with the goal of regaining independent self-care as soon as possible. The patient's emotional and spiritual needs were addressed through comfort measures tailored to their preferences, respect for their beliefs, and professional spiritual care to reduce anxiety. Family members and the patient were encouraged to participate in the treatment plan through individualized care and education. Prior to discharge, a referral was made to the discharge preparation team, and social workers provided welfare resources. Timely follow-up interviews were conducted during return visits to ensure continuous, comprehensive care. This case report aims to share the experience of caring for this patient and provide insights into the application of clinical care.