運用多重感覺刺激輔助頭部創傷病患甦醒之加護照護經驗

The Experience of Applying Multi-sensory Stimulation ICU for Arousing a Patient with Traumatic Brain Injury in Intensive Care

車禍為頭部創傷之主因，嚴重者會導致病患意識喪失甚至死亡。本文為描述一位車禍導致嚴重頭部創傷的青少年，及其主要照顧者於加護期間的護理經驗。照護期間自102年1月28日至 102年2月16日，運用Gordon十一項健康型態評估，發現個案有顱內調適能力降低，認知領悟、自我概念型態改變，及其主要照顧者有焦慮等問題。照護期間除維持病患生命徵象、足夠腦灌注壓、避免顱內壓增高引起腦部二次傷害，並運用多重感覺刺激融入護理活動，且使用關懷、陪伴、傾聽、支持，及鼓勵家屬參與護理活動之進行來降低照顧者焦慮。最終，個案昏迷指數由入院時4分至轉出加護病房時為11分，其案母的焦慮與不安皆獲得改善，筆者藉此個案照護經驗的分享，提供給臨床護理人員作為參考。

Motor vehicle accidents are the first cause of head injury worldwide, and severe head injury cases may cause conscious disturbance and death. This report is a case of a young adult patient suffering from a motor vehicle accident leading to severe head injury who underwent three rounds of surgical procedures (his mother was the informal caregiver). This case was followed from 28th January to 15th February 2011 by using Gordon’s 11 functional health patterns. Patient’s cognitive-perceptual and self-perception-self-concept patterns were altered. Anxiety was also noted on his informal caregiver due to the patient’s condition. During the intensive care period, maintaining the patient’s vital signs and cerebral perfusion pressure were essential to avoid secondary neuronal injury. Multi-sensory stimulation, accompanying caring, supporting, listening and encouraging the patient’s family members involved in patient care were very important to reduce the informal caregivers’ anxiety. Finally, the patient consciousness improved from GCS 4 to GCS 11 before being discharged from the ICU. The patient’s primary informal caregiver, his mother, also showed anxiety improvement. This was a successful case with traumatic brain injury recovery from a coma.