照護一位胸部外傷病人脫離呼吸器之護理經驗

A Nursing Experience of Weaning the Ventilator for a Thoracic Trauma Patient

本文描述一位68男性因工作事故導致肋骨骨折合併氣血胸，由於多次呼吸訓練失敗後，接受氣切造口手術，病情穩定後轉至慢性呼吸照護病房。個案因擔心無法成功脫離呼吸器，會成為家人的累贅及負擔，所以經常面露憂愁及不安，故而引發筆者探討之動機。護理期間自2024年1月2日至3月9日，筆者藉由觀察、身體評估、筆談、唇語會談及病歷查閱等方式收集資料，運用Gordon十一項功能性健康型態進行評估，確立個案有：呼吸機戒斷反應功能失常、焦慮及照顧者角色緊張等健康問題。照護過程中，運用跨團隊合作共同訂定肺復原運動、上下肢肌力運動及呼吸訓練計畫，以提升個案呼吸肌力，並監測呼吸狀態，直到成功脫離呼吸器。筆者運用音樂治療及薰衣草精油吸入等輔助療法，並透過轉移注意力及放鬆技巧，經醫療團隊及家屬心理支持及正向鼓勵，提升個案自信心並減輕心理焦慮。筆者透過同理照顧者壓力，運用多媒體影片及QR-code電子衛教單張，增加家屬對居家照護技巧的認知，以減輕照顧者的壓力。建議本院可以建立氣切個案的語言發聲相關訓練，增進個案的表達能力，提升醫病有效溝通，使呼吸訓練過程更加順利，並能更快理解個案之想法與需求。

This case report presents a 68-year-old male who sustained rib fractures with hemopneumothorax due to a workplace accident. Following multiple unsuccessful attempts at respiratory training, a tracheostomy was performed, and the patient was transferred to a chronic respiratory care ward after stabilization. The patient exhibited persistent anxiety and distress stemming from concerns about prolonged ventilator dependence and becoming a burden to his family, this situation prompted the author to further explore the case. During the nursing care period, from January 2 to March 9, 2024, data were collected through observation, physical assessment, written communication, lipreading, and chart review. Based on Gordon’s Functional Health Patterns, the primary health issues identified were: dysfunctional ventilatory weaning response, anxiety, and caregiver role strain. During the care process, a multidisciplinary team collaborated to develop a pulmonary rehabilitation program, including upper and lower limb strengthening and respiratory training, enhancing the patient's respiratory muscle strength. The patient’s respiratory status was closely monitored until successful ventilator weaning was achieved. Using the music therapy and lavender oil inhalation, along with relaxation and distraction techniques. Support and encouragement from the medical team and family helped boost the patient's confidence and reduce anxiety. By empathizing with the caregiver's stress, the author utilized multimedia videos and QR-code-based electronic educational materials to enhance the family's knowledge of home care techniques, thereby alleviating caregiver burden. It is recommended that tracheostomy-specific voice rehabilitation programs be developed to enhance patient-provider communication and support ventilator weaning outcomes, streamline the respiratory training process, and quickly understand patients’thoughts and needs.