- 期刊
小腸移植病人術後的藥事照護
Post-Operation Pharmaceutical Care of Small Intestinal Transplantation Recipients
摘要
小腸移植手術提供小腸衰竭的病人脫離靜脈營養以及提升生活品質的機會，但因小腸器官本身的特性，使得小腸移植的病人相較於其他的器官移植在術後免疫抑制劑的選用、抗排斥藥品的濃度調整、術後營養支持、器官排斥預防、移植物對抗宿主疾病、感染等併發症的處理有許多的困難與挑戰。本院是臺灣第一家施行小腸移植手術的醫院，截至2015年1月為止已有13名成功案例，手術成功率100%。而移植後免疫抑制療程固定使用rabbit antithymocyte globulin（rATG）為主的induction therapy並配合tacrolimus使用，五年內病人存活率為61%。本文回顧過去文獻探討並對照本院經驗，分享小腸移植病人免疫抑制劑的使用及術後常見併發症的處理。
並列摘要
Small intestinal transplantation is the only treatment to wean patients of intestinal failure from complications due to total parenteral nutrition. Because of the complexity of the surgery and the unique characteristic of grafts, there are difficulties in choosing immunosuppresants, adjusting the serum level of drugs, nutrition support and managing complication such as rejection, graft versus host disease and infection. Our institution is the first medical center in Taiwan performing small intestinal transplantation. We have performed the surgery on 13 patients with intestinal failure, and the success rate is 100%. The protocol indicated the use of rabbit antithymocyte globulin (rATG) as induction agent and followed by tacrolimus monotherapy, and the five-year survival rate is 61%. In this article, we reviewed the cases of our institution and the published literatures to discuss the pre-and post-operational immunosuppression therapy and the management of the post-operational complications.
延伸閱讀
- 黃秋禎、陳詠真（2019）。一位短腸症患者行小腸移植手術全期護理經驗。志為護理-慈濟護理雜誌，18(3)，114-124。https://www.airitilibrary.com/Article/Detail?DocID=16831624-201906-201906270010-201906270010-114-124
- 孫文蕙、劉麗娟、姜貴明、陳芸（2015）。台灣小腸移植病患術後的營養照護經驗分享。臺灣營養學會雜誌，40(3)，87-93。https://doi.org/10.6691/NSJ.201509_40(3).0001
- 王玉碧（1994）。外科腸胃術後全腸胃道飲食之護理。長庚護理，5(1)，45-50。https://www.airitilibrary.com/Article/Detail?DocID=10267301-199406-5-1-45-50-a
- 王凌峰、戴志峰（2022）。Surgical Indications and Preoperative Preparation。台灣耳鼻喉頭頸外科雜誌，56()，18-21。https://doi.org/10.6286/jtohns.202203/SP_56.0003
- 陳強儀、周曉禎、卜宜芝、余明錚、徐濬婕、蔡慧玲、樹金忠、陳晉興（2015）。Functional Decline after Abdominal Operation and Complication of Intra-Abdominal Infection。台灣老年醫學暨老年學雜誌，10(1)，42-53。https://doi.org/10.29461/TGG.201502_10(1).0004