活体小肠移植受者多学科协作护理方案的制订及应用

doi:10.3761/j.issn.0254-1769.2021.02.010

摘要/Abstract

摘要：

目的制订活体小肠移植受者多学科协作护理方案,并评价其临床应用效果。方法组建多学科协作团队,针对活体小肠移植的护理难点,查阅指南、操作规范及相关文献,制订多学科协作护理方案,包括营养管理、感染预防和控制、排斥反应监测、免疫抑制、康复运动、心理干预及延续性照护。选取2019年8月—2020年3月在浙江省某三级甲等医院移植中心接受亲属活体小肠移植的6例成人受者作为应用对象,实施多学科协作护理方案,并评价其术后康复情况。结果本组共6例亲属活体小肠移植受者,其中1例受者术后腹水培养提示屎肠球菌感染,经积极干预后感染得到控制;急性排斥反应发生率为0。6例受者病情稳定,移植肠功能恢复良好,顺利出院,并于术后3个月内如期完成造口回纳术。出院后随访依从性达100%;他克莫司血药浓度控制良好。结论应用多学科协作护理方案可降低并发症的发生,加速术后康复进程,并确保活体小肠移植受者从医院到家庭这一过渡期的安全性。

关键词: 器官移植, 小肠, 多学科团队, 围手术期护理

Abstract:

Objective To develop a multidisciplinary nursing program for recipients of living small bowel transplantation and to evaluate its effectiveness. Methods A multidisciplinary team was set up,consulting the guidelines,operation specifications and related literature according to the nursing difficulties. A multidisciplinary nursing program was developed,including nutrition management,infection prevention and control,rejection monitoring,immunosuppression,rehabilitation exercise,psychological interventions and continuous care. 6 adult recipients of living small bowel transplantation admitted to a level A tertiary hospital from August 2019 to March 2020 were selected, to carry out a multidisciplinary nursing program and to evaluate their postoperative rehabilitation. Results Among 6 recipients in this group,1 case was diagnosed enterococcus faecium infection with ascites culture. The infection was controlled after active interventions,and there was no acute rejection case. The 6 recipients were discharged from the hospital after their condition was stable,and the stoma was completed as scheduled within 3 months after the operation. The follow-up compliance after discharge reached 100%;blood drug concentration was well controlled. Conclusion The application of the multidisciplinary nursing program can reduce the incidence of complications,accelerate the process of postoperative rehabilitation,and ensure the safety of recipients during the transition period from hospital to family.

Key words: Organ Transplantation, Small Intestine, Multidisciplinary Team, Perioperative Nursing

卢芳燕, 汤洒潇, 王燕, 岑罗旭, 戴燕红, 王华芬. 活体小肠移植受者多学科协作护理方案的制订及应用[J]. 中华护理杂志, 2021, 56(2): 218-224.

LU Fangyan, TANG Saxiao, WANG Yan, CEN Luoxu, DAI Yanhong, WANG Huafen. Development and application of a multidisciplinary nursing program for recipients of living small bowel transplantation[J]. Chinese Journal of Nursing, 2021, 56(2): 218-224.

参考文献 19

[1]	王勉, 陈冬利, 吴国生 , 等. 小肠移植受者长期疗效影响因素及其监控防治[J]. 器官移植, 2017,8(4):333-336.
	Wang M, Chen DL, Wu GS , et al. Long-term outcome of small bowel transplantation recipients:influencing factors,monitoring,prevention and treatment[J]. Organ Transplant, 2017,8(4):333-336.
[2]	Yildiz BD . Where are we at with short bowel syndrome and small bowel transplant[J]. World J Transplant, 2012,2(6):95-103.
[3]	吴国生 . 临床活体小肠移植国内外研究进展[J]. 中华结直肠疾病电子杂志, 2013,2(5):221-223.
	Wu GS . Advances in living-related small intestinal transplantation[J]. Chin J Color Dis Electron Ed, 2013,2(5):221-223.
[4]	中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 中国成人小肠移植临床诊疗指南(2016版)[J]. 中华器官移植杂志, 2017,38(1):45-50.
	Society of organ transplantation, Chinese medical association , Organ transplantation medical doctor society of Chinese medical doctor association. Guidelines for clinical diagnosis and treatment of small bowel transplantation in China adults(2016 edition)[J]. Chin J Organ Transplant, 2017,38(1):45-50.
[5]	中华医学会器官移植学分会. 小肠移植护理技术操作规范[J]. 实用器官移植电子杂志, 2019,7(5):346-348.
	Society of organ transplantation, Chinese medical association . Specification of nursing practice for small bowel transplantation[J]. Prac J Organ Transplant Electron Ed, 2019,7(5):346-348.
[6]	秦凯强, 楚晓娜, 成良栋 , 等. 超短肠综合征病人肠康复治疗探讨(附1例报告)[J]. 青岛大学医学院学报, 2017,53(2):247-248.
	Qin KQ, Chu XN, Cheng LD , et al. Intestinal rehabilitation treatment of short bowel syndrome(case report)[J]. J Qingdao Univ Med Sci, 2017,53(2):247-248.
[7]	王丽妮, 马晓亮, 计根林 , 等. 血型不符活体小肠移植术的麻醉管理一例[J]. 临床麻醉学杂志, 2015,31(10):1039-1040.
	Wang LN, Ma XL, Ji GL , et al. A case of anesthesia management for living donor small bowel transplantation with inconsistent blood type[J]. J Clin Anesthesiol, 2015,31(10):1039-1040.
[8]	Kesseli S, Sudan D . Small bowel transplantation[J]. Surg Clin North Am, 2019,99(1):103-116.
[9]	江方正, 吴莉莉, 叶向红 , 等. 短肠综合征患者的护理进展[J]. 解放军护理杂志, 2016,33(7):36-39.
	Jiang FZ, Wu LL, Ye XH , et al. Nursing progress of patients with short bowel syndrome[J]. Nurs J Chin PLA, 2016,33(7):36-39.
[10]	沈鸣雁, 卢芳燕, 王仁芳 , 等. 针对胰腺癌患者的多学科专业化护理实践与成效[J]. 中华护理杂志, 2016,51(5):542-546.
	Shen MY, Lu FY, Wang RF , et al. Effectiveness of nursing care of patients with pancreatic cancer conducted by multi-disciplinary team[J]. Chin J Nurs, 2016,51(5):542-546.
[11]	陈芸, 蔡雅慧 . 小肠移植受者术前评价与管理[J]. 实用器官移植电子杂志, 2016,4(3):171-176.
	Chen Y, Cai YH . Preoperative evaluation and management of small bowel transplantation recipients[J]. Prac J Organ Transplant Electron Version, 2016,4(3):171-176.
[12]	张晓宁, 薛钰, 周红梅 . 小肠移植围术期的护理诊断[J]. 实用医药杂志, 2014,31(11):1033-1035.
	Zhang XN, Xue Y, Zhou HM . Perioperative nursing diagnosis of small bowel transplantation[J]. Pract J Med Pharm, 2014,31(11):1033-1035.
[13]	梁廷波 . 加速康复外科理论与实践[M]. 北京: 人民卫生出版社, 2018: 180.
	Liang TB. Theory and practice of enhanced recovery after surgery[M]. Beijing: People's Medical Publishing House, 2018: 180.
[14]	严芳, 姚丰菊, 李拴荣 , 等. 同伴支持在社区精神分裂症患者中的应用[J]. 中华护理杂志, 2019,54(10):1545-1550.
	Yan F, Yao FJ, Li SR , et al. Application of peer support in community mental health services to patients with schizophrenia[J]. Chin J Nurs, 2019,54(10):1545-1550.
[15]	米元元, 黄培培, 董江 , 等. 危重症患者肠内营养不耐受预防及管理的最佳证据总结[J]. 中华护理杂志, 2019,54(12):1868-1876.
	Mi YY, Huang PP, Dong J , et al. Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients[J]. Chin J Nurs, 2019,54(12):1868-1876.
[16]	宋剑平, 卢芳燕, 吴小燕 , 等. 肝切除术后患者早期活动的最佳证据应用[J]. 中华护理杂志, 2019,54(8):1175-1179.
	Song JP, Lu FY, Wu XY , et al. Implementation of best evidence on early mobilization among patients after liver resection[J]. Chin J Nurs, 2019,54(8):1175-1179.
[17]	宋剑平, 金静芬, 俞申妹 , 等. 六步标准沟通流程在提高护士沟通能力中的应用研究[J]. 中华护理杂志, 2017,52(1):63-66.
	Song JP, Jin JF, Yu SM , et al. The application of six-step standardized communication procedure in improving the communication ability of nurses[J]. Chin J Nurs, 2017,52(1):63-66.
[18]	王燕, 卢芳燕 . 一例亲属活体小肠移植术后并发屎肠球菌感染患者的护理[J]. 中国实用护理杂志, 2020,36(23):1819-1822.
	Wang Y, Lu FY . Nursing care of a patient with enterococcus faecalis infection after living relative small bowel transplantation[J]. Chin J Pract Nurs, 2020,36(23):1819-1822.
[19]	Bodeur C, Aucoin J, Johnson R , et al. Clinical practice guidelines-nursing management for pediatric patients with small bowel or multivisceral transplant[J]. J Spec Pediatr Nurs, 2014,19(1):90-100.