一位米勒費雪症候群病人重症照護經驗

Nursing Care Experiences in the Intensive Care Unit for a Patient with Miller Fisher Syndrome

本文是探討一位罹患米勒費雪症候群的女性個案，因急性周邊神經病變導致突發性肢體無力，入住加護病房行血漿分離術之照護經驗。護理期間自2020年4月9日至2020年4月20日，運用Gordon十一項健康功能評估，藉由會談、觀察、理學檢查及病歷收集資料，期間個案因急性發作導致呼吸肌無力清除分泌物、肢體失去自主控制力、對病情預後不確定感、以及中斷收入影響經濟，造成一連串身心衝擊。經資料收集分析後，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。照護過程中，藉由加強橫膈肌及咳嗽功能訓練，高頻胸壁震盪治療等，達有效咳痰能力，協同復健團隊共擬復建計畫，執行平衡訓練及眼球運動，運用跨團隊中醫會診及早介入方式，改善肌肉控制力。在心理照護方面，透過提升疾病認知，宗教支持及轉介社工尋求社會資源，強化心靈照護，改善焦慮之問題。經由此照護經驗了解，根據病人神經功能侵犯程度擬定不同時期的照護與復健計畫是重要的，需依受限的加護病房環境找出應變之道，鼓勵個案持續復健，以降低臥床期間肌力流失，進而提升及延續復健品質，期望此經驗可提供未來護理人員照顧此類個案之參考。

This study reports the nursing experience of a female patient diagnosed with Miller Fisher syndrome who experienced sudden limb weakness owing to acute peripheral neuropathy and underwent plasmapheresis in the intensive care unit (ICU). The nursing period extended from April 9 to 20, 2020. Data were collected through interviews, observations, physical examinations, and a review of medical records, and Gordon’s Eleven Functional Health Patterns was used for assessment. During this period, the patient experienced an acute episode, which led to a series of physical and psychological impacts including ineffective clearance of respiratory secretions owing to respiratory muscle weakness, loss of autonomous control of limbs, uncertainty about disease prognosis, and economic distress due to interrupted employment. Data analysis identified several health issues including ineffective airway clearance, mobility impairment, and anxiety. The care process involved strategies such as diaphragm strengthening and cough function training and using high-frequency chest wall oscillation for effective sputum clearance. A collaborative rehabilitation plan including balance and eye movement training was developed with the rehabilitation team. Early interventions with cross-team collaboration, including traditional Chinese medicine consultations, were implemented to enhance muscle control. Psychological care focused on increasing disease awareness, providing religious support, and involving social workers to access social resources to enhance the patient’s mental well-being and address anxiety. This care experience highlights the importance of tailoring care and rehabilitation plans to the different phases of the disease and degrees of nerve function involvement. Adapting strategies within the constraints of the ICU and encouraging continuous rehabilitation are crucial to reduce muscle strength loss during bed rest, thereby enhancing and extending the quality of rehabilitation. The patient’s experience regarding nursing care can serve as a valuable reference for healthcare professionals to manage similar cases in the future.