照護一位活體雙肺葉移植學齡期兒童術後復健之加護經驗

本文旨在探討一位學齡期兒童因急性呼吸窘迫症候群及間質性肺纖維化，接受活體雙側肺葉移植術後復健之加護經驗，個案因肺功能嚴重損傷，接受父母捐贈的肺臟，進行「活體雙肺葉移植」，女童經歷術前評估及術後長期住加護病房復健，筆者於2022年10月25日至2022年12月15日照護期間，經由直接照護、身體評估、會談、病歷查閱以及與病童及其家屬互動等方式進行資料收集，並將收集的資料加以分析，歸納出活動無耐力、營養少於身體需要、焦慮等健康問題。在肺臟移植術後復健期間，跨領域團隊合作制定照護計畫，主動關懷，鼓勵女童與父母表達感受，透過圖卡教導飲食管理及利用治療性遊戲促進早期肺部復健運動，改善重症病人心肺耐力，鼓勵父母參與照護、執行出院準備與衛教。此為臺灣首例活體肺葉移植，期許此護理經驗能對日後照顧此類個案之照護團隊，提供護理過程與照護經驗之參考。

關鍵字

活體肺葉移植；治療性遊戲；復健運動；營養；焦慮

並列摘要

The post-operative intensive care experience of a school-aged child who received living-donor bilateral lobar lung transplantation due to acute respiratory distress syndrome and interstitial pulmonary fibrosis is discussed in this paper. The patient received lungs donated by her parents in a "living-donor bilateral lobar lung transplantation" due to severe lung function impairment. The patient felt anxious due to her long-term hospitalization for preoperative evaluation, various invasive treatments, and postoperative rehabilitation. During the care period from October 25th, 2022, to December 15, 2022, the author collected data via direct care, interviews, medical record reviews, and interactions with the patient and her family. An assessment of the patient's physical, mental, and social integrity was made, and the collected data were organized and analyzed to identify health issues such as lack of activity endurance, imbalanced nutrition below bodily requirements, and anxiety. After the lung transplantation operation, the interdisciplinary team worked collaboratively to develop a care plan to improve cardiopulmonary endurance and enhance the quality of care for the patient through early care and rehabilitation via proactive care. This care plan included encouraging the patient and her parents to express their fears and feelings and using flashcards to teach them about dietary management and the proper performance of lung rehabilitation. These measures encouraged the parents to engage in care, properly prepare for discharge care, and receive care education. As this is the first case of living-donor lobar lung transplantation in Taiwan, this valuable nursing experience is expected to provide future care teams with a reference on the related nursing process and care experience for similar cases.

並列關鍵字

living-donor lobar lung transplantation ； therapeutic play ； rehabilitation ； nutrition ； anxiety

參考文獻

許瀚水（2018）．肺臟移植簡介．臨床醫學月刊，81（5），274–276。[Hsu, H.-S. (2018). Introduction to lung transplantation. Clinical Medicine, 81(5), 274–276.] https://doi.org/10.6666/ClinMed.201805_81(5).0049

曾筠婷、王一家（2023）．兒童雙肺移植之術後呼吸照護經驗〔論文摘要〕．呼吸治療，22（2），113–114。[Tseng, Y.-T., & Wang, Y.-C. (2023). Postoperative respiratory care of bilateral lung transplantation in pediatric [Paper abstract]. Journal of Respiratory Therapy, 22(2), 113–114.] https://doi.org/10.6269/JRT.202307_22(2).0039

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Black, R. J., Bogaardt, H., McCabe, P., Glanville, A. R., MacDonald, P., & Madill, C. (2019). Clinical predictors for oropharyngeal dysphagia and laryngeal dysfunction after lung and heart transplantation. International Journal of Language & Communication Disorders, 54(6), 894–901. https://doi.org/10.1111/1460-6984.12492

Challa, C., Geng-Ramos, G., Gray, L., Orshan, T., Thackeray, L., & Gupta, P. (2023). Anxiety in children: A review on how to address it in the perioperative setting post-pandemic. Pediatric Anesthesia, 33(6), 422–426. https://doi.org/10.1111/pan.14656

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照護一位活體雙肺葉移植學齡期兒童術後復健之加護經驗

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