一位神經性排尿障礙個案行腸道膀胱擴大整型術之護理經驗

Nursing experience of caring a patient with neurogenic voiding dysfunction undergoing enterocystoplasty

本文描述一位24歲男性因頸髓損傷導致導尿管放置困難及頻繁自主神經反射，診斷神經性因排尿障礙入院，行腸道膀胱擴大整形術之護理經驗。筆者為泌尿科脊髓損傷排尿障礙個案管理師，護理期間於2023年5月28日至6月22日，運用Gordon十一項健康功能型態評估，並透過身體評估、觀察、會談、查閱病歷及實際照護確立個案有焦慮、胃腸能動性失常、排尿型態障礙之健康問題。照護期間運用開放性問題引導個案說出對於手術的看法、鼓勵表達並傾聽感受，鼓勵親友陪伴，於手術前偕同醫療科提供手術影片，減輕個案焦慮情緒。術後鼓勵即早下床及嚼口香糖促進腸胃蠕動，營養師介入共同制定飲食計畫並採漸進式飲食，改善胃腸能動性失常問題。另外配合排尿日誌運用，協助指導定時清潔導尿，使術後漏尿量降至50ml，進而改善排尿障礙問題。藉由護理措施介入，提升個案對手術後自我照顧知識，調適疾病治療過程，促進生活品質。期望藉此經驗分享，提供日後照護類似個案之臨床護理師經驗之參考。

This article details the nursing care of a 24-year-old male with neurogenic voiding dysfunction resulting from a cervical spinal cord injury, a condition complicated by difficult catheterization and frequent autonomic dysreflexia. Between May 28 and June 22, 2023, the patient underwent enterocystoplasty, and a holistic assessment using Gordon’s 11 Functional Health Patterns identified key nursing problems: anxiety, gastrointestinal dysmotility, and urinary pattern disorders. To manage these, the nursing team utilized open-ended communication and surgical orientation videos to alleviate preoperative anxiety, while fostering a strong support system through family and friends. Postoperatively, the patient was encouraged to engage in early ambulation and gum-chewing to stimulate bowel function, supported by a progressive dietary plan developed in collaboration with a dietitian. Furthermore, the implementation of a voiding diary and structured education on clean intermittent catheterization effectively managed his urinary dysfunction, reducing postoperative leakage to 50 mL This comprehensive interdisciplinary approach not only equipped the patient with essential self-care knowledge but also significantly enhanced his transition to recovery and overall quality of life, offering a valuable clinical framework for managing similar complex spinal cord injury cases.