一位抗麩胺酸鹽受體腦炎病人脫離呼吸器之照護經驗

Care Experience Gained from Weaning a Patient with Anti-N-methyl-Daspartate Receptor Encephalitis from a Ventilator

本文描述一位年輕成年女性因抗麩胺酸鹽受體腦炎導致呼吸衰竭放置氣管內管，經歷一次拔管失敗及對病程的不確定感，部分生活起居需仰賴他人照顧，在心理上產生莫大的衝擊與壓力，常出現情緒低落及哭泣等負向行為反應，因此引發筆者想進一步探討的動機。2021年4月2日至2021年4月15日護理期間藉由病歷查閱、觀察、會談及傾聽技巧進行資料收集，運用Gordon十一項健康功能型態進行評估，確立個案有呼吸道清除功能失效、身體活動功能障礙、焦慮等健康問題。運用同理心、主動關懷與傾聽，建立良好護病關係，提供個別性的照護計畫，鼓勵家屬共同參與，並給予信心與鼓勵，藉由跨團隊的合作，會同復健科改善自我照顧能力，協同呼吸治療師加強胸腔物理治療，運用愛必佳振盪式呼氣正壓器，教導深呼吸咳嗽技巧，促進肺部分泌物排除，維持呼吸道通暢，鼓勵個案表達內心的感受，以正向的態度面對疾病的衝擊，儘早回歸正常生活，期望藉此案例提供照護此類個案之參考。

In this paper, we describe our experience of the care a young adult female patient who required endotracheal intubation due to respiratory failure caused by anti-N-methyl- D-aspartate receptor encephalitis. She had experienced a failed extubation attempt, was accordingly apprehensive regarding the course of the disease, and was partially dependent on others for her activities of daily living. These factors contributed to considerable psychological distress and anxiety in the patient, which were manifested as frequent negative behavioral responses, such as low mood and crying. These conditions prompted further investigation into the issues faced by the patient. During the nursing care period between April 2nd and 15th, 2021, data collection was performed based on medical record reviews, observations, interviews, and the use of listening skills. On the basis of an assessment using Gordon’s 11 Functional Health Patterns, it was confirmed that the patient had several health issues, including ineffective airway clearance, impaired physical mobility, and anxiety. Efforts were accordingly made to foster a good nurse–patient relationship based on empathy, proactive care, and listening. An individualized care plan was formulated, family engagement in patient care was encouraged, and confidence and encouragement were provided. Through multidisciplinary team collaboration, the self-care capabilities of the patient were improved with support from the rehabilitation department, and chest physiotherapy was enhanced under the assistance of a respiratory therapist. An Aerobika oscillating positive expiratory pressure device was employed to provide guidance on deep breathing and coughing techniques, with the aim of promoting the clearance of pulmonary secretions and maintenance of airway patency. The patient was also encouraged to openly express her inner feelings, adopt a positive attitude toward the effects of the disease, and to return to a normal life style as soon as possible. It is hoped that this case description can serve as reference for the provision of nursing care for similar cases in the future.