一位肺炎合併呼吸衰竭脫離呼吸器個案之護理經驗

Weaning from the Respirator: a Case Report

本文描述一位72歲女性因肺炎引發呼吸衰竭導致意識不清，需藉由氣管內插管使用呼吸器治療維持生命，在病情逐漸穩定後雖面臨生理上的不適，但在醫護人員及家屬的陪伴、鼓勵下克服了精神壓力成功脫離呼吸器。筆者在97年1月16日到2月15日照護期間，運用Gorden十一項功能健康型態進行整體性評估，確立個案有四個主要問題：1.現存性皮膚完整性受損問題2.氣體交換功能障礙3.睡眠型態紊亂4.無力感。個案在入住加護病房急性期間，因面臨脫離呼吸器訓練失敗便產生了無力感，藉由在照護期間臨床多方面的評估，建立治療性人際關係並持續性的關懷，接受個案負面情緒，鼓勵個案抒發內心感受增加自我信心，使個案在護理過程中獲得正向的呼吸器脫離成功經驗感受。筆者希望藉由本文，能讓臨床護理人員了解如何協助類似個案脫離呼吸器，減低呼吸器使用頻率，以獲得最佳的生活品質。

This article describes a patient (a 72-year-old female) with respiratory failure caused by pneumonia. The patient required endotracheal intubation with a ventilator to keep her alive. Although the patient was mentally confused and physically uncomfortable, the health care staff and family caregivers were supportive.The author assessed the patient based on Gordon's eleven functional health patterns during a period of care from January 16, 2008 to February 15, 2008. Four main problems were noted: impairment of skin integrity, impairment of gas exchange, disturbance of sleep pattern and feelings of powerlessness. When the patient was in the acute stage of illness in the intensive care unit, she had failed in ventilator-weaning training and felt that she could not help herself. After making a complete assessment, the author developed a therapeutic relationship with the patient and expressed concern about her health. The author also accepted the negative emotions of the patient and encouraged her to express herself freely. The patient eventually felt less stress and more confidence, accepted ventilator-weaning training and succeeded in weaning herself off the ventilator. The author hopes that this approach can help nurses assist patients in weaning themselves away from ventilators and enjoy a better quality of life.