專科護理師應用即時重點式超音波於整合醫學照護

Application of Point-of-Care Ultrasound by Nurse Practitioners in Integrated Medical Care

即時重點式超音波（point-of-care ultrasound，POCUS）是一項具即時性、非侵入性與高敏感度的臨床影像技術，廣泛應用於急重症與多重共病病人的診斷與評估中。其可降低診斷延遲、病人運送風險及醫療成本，對於提升醫療效率與照護品質具有重要價值。隨著台灣人口高齡化與慢性病人增加，整合醫學照護模式逐漸成形，專科護理師（nurse practitioner，NP）在其中扮演病人照護主力角色。專科護理師除進行直接照護與健康教育外，也積極應用臨床評估與診斷輔助工具，特別是在POCUS的操作與初步判讀上。本文分享整合醫學科專科護理師應用POCUS之臨床案例，包括淋巴癌導引切片、非結石性膽囊炎、術後遺留結石、腸胃道穿孔及前列腺肥大的協助診斷。這些案例顯示POCUS可以即時且有效地提供影像的評估工具，並提升評估效率與照護品質。POCUS除了是醫師臨床照護中不可或缺的工具外，近年來也成為專科護理師有利的臨床評估工具，未來應結合制度化訓練、標準化操作與跨專業合作，進一步推進以病人為中心的整合照護模式，提升臨床決策效能與病人福祉。

Point-of-care ultrasound (POCUS) is a real-time, noninvasive, and highly sensitive imaging modality that has been widely utilized in the diagnosis and assessment of critically ill patients and individuals with multiple comorbidities. POCUS facilitates timely clinical decision-making by reducing diagnostic delays, minimizing risks associated with patient transportation, and lowering healthcare costs, thereby improving healthcare efficiency and quality of care. With the rapid aging of the population and the increasing prevalence of chronic diseases in Taiwan, integrated care models have become progressively established, with Nurse Practitioners (NPs) playing a pivotal role in patient management and continuity of care. In addition to providing direct patient care and health education, NPs are increasingly involved in clinical assessment and the application of diagnostic adjuncts, particularly in the performance and preliminary interpretation of POCUS examinations. This article presents a series of clinical cases demonstrating the application of POCUS by NPs within the Department of Integrated Medicine, including ultrasound-guided biopsy for lymphoma, acute acalculous cholecystitis, retained postoperative biliary stones, gastrointestinal perforation, and benign prostatic hyperplasia. These cases illustrate that POCUS serves as an effective bedside imaging tool capable of providing immediate diagnostic information, enhancing clinical assessment efficiency, and improving the quality of patient care. Beyond its indispensable role in physician-led clinical practice, POCUS has increasingly become a valuable assessment tool for NPs. Future efforts should focus on the implementation of structured training programs, standardized scanning protocols, and interprofessional collaboration to further advance patient-centered integrated care, optimize clinical decision-making, and improve patient outcomes.