胃癌術後化學合併高溫治療之護理經驗－－自我照顧模式之運用

Chemo-hyperthermia Therapy in Post-operative Gastric-carcinoma Cote - Practical Applications of Self-care Deficit Nursing Theory

本個案報告主要探討胃癌術後化學合併高溫治療之護理過程。早期胃癌症狀不明顯，發現時已多處轉移，治療困難預後極差；近年嘗試病灶切除後，將化學藥物加入高溫溶液注入腹腔灌洗以提高預後；但措施繁複易發生體液電解質不平衡，病患焦慮不安影響復原，護理需密切評估正確判斷處置，方能提供促進復原的環境。此個案復原快速未有合併症，實有賴手術成功及術後醫護策略得宜。護理透過身、心靈、社會整體性評估，確立其早期治療性自我照顧缺失，予完全代償性護理措施如穩定生命徵象、補充大量體液電解質，滿足其治療性自我照顧缺失需求；病況穩定後以部份代償性及支持/教育護理技巧，培養自我照顧意願和能力，為其日後自我照顧及恢復家庭角色功能提供了早期準備，是為促其整體性健康因素之一。

This case of gastric-carcinoma was treated with operation combining chemo-hyperthermia and self-care deficit nursing theory in post-operation in ICU. If the gastric-carcinoma is not found in the early stage, it would be difficult to cure and the prognosis poor. Recently, intra abdominal local continous irrigation with antineoplastics agents was added in hyperthermia of normal saline in post-operation elevating the prognosis, but the procedure was complicated including the massive loss of body fluid, electrolytes throuth the solution when irrigated, and the discomfort could induce theamtment failure. So, there needs nursing intensive observation, immediate charge and implement to make recovery possible. This case recovered shortly, depending on smooth operation, and effective stratege of ICU care. The nursing supported fully compensatory intervention, such as hemodynamic stabilization, constant electrolyte balance monitor, and supporting/education intervention, as estimating encourage self-care training in the late stable stage for the discharge of family function, mother role and high life quality of postoperation.