肺臓和心肺移植及其物理治療

Physical Therapy in Lung and Heart-Lung Transplantation

吳英黛(Ying-Tai Wu)

《中華民國物理治療學會雜誌》 18卷1期 (1993/03) Pp. 100-108

https://doi.org/10.29616/JPTAROC.199303.0011

摘要

肺臟和心肺移植為一些患有末期的肺部和心肺疾病者帶來生機，向於免疫抑制療法，外科手術、肺臟保存方法以及對排斥診斷和處理上的進步，病人的存活率在過去十年有長足的進步，術後肺部的併發症包括再植入反應、肺部排斥、肺部感染和閉塞性的細支氣管炎。閉塞性細支氣管炎仍是目前最嚴重的慢性併發症，會造成限制型和阻塞型的換氣缺損，其發生的機轉可能與感染或排斥有關。病人在移植後其氣道纖毛排除黏液的功能較正常為差，休息和睡眠時的呼吸型態則與正常無異，在低限運動和最大運動量時的換氣量也都正常，但呼吸頻率的增加幅度較潮氣量的增加為大，限制動動的因素主要來自心臟血管系統。完整的物理治療計劃應包括術前和術後的處理。術前的物理治療目標在於盡可能提升其運動耐力和功能，並維持等待手術期間情緒的健康。術後的處理則在協助病人早日脫離呼吸器，維持肺部清潔避免感染，以及早期活動增加病人的運動耐力，病人出院後仍可參加門診病人的物理治療運動計劃，以期進一步增加運動能力和提升生活品質。

關鍵字

肺臓移植 ； 心肺移植 ； 物理治療

並列摘要

Lung and heart-lung transplantation are evolved for patients with end-stage cardiopulmonary and pulmonary diseases. Advances in immunosuppression, operative techniques, lung preservation, selection criteria of donar and recipient, techniques of diagnosis and manage-merit of rejection have been occurred to improve the survival over the past decade. Postoperative pulmonary complications include the reimplantation response, lung allograft rejection, pulmonary infection, obliterative bronchiolitis. Obliterative bronchiolitis remains as the serious chronic complication which decreases the quality of survival. Some decreases in mucociliary function have been reported. Pulmonary function, minute ventilation, gas exchanges, and breathing pattern at rest are within normal limits if there is no pulmonary complication. Pulmonary denervation does not seem to affect the match of ventilation and metabolism during exercise. Limitations to exercise after heart-lung transplantation are mainly from the denervated heart. Pre- and postoperative physical therapy interventions, including pulmonary care, reconditioning, and exercise training are important to promote the general care for these patients.

並列關鍵字

Lung transplantation ； Heart-lung transplantation ； Physical therapy