護患情境會話

單肺移植急性排斥反應病人的護理

Nursing Care for a Patient with Acute Rejection after a Single-Lung Transplant

背景

病人楊先生，51歲。因IV期矽肺，雙側自發性氣胸而入院。行左側肺同種異體肺移植術。急性排斥反應為器官移植成功的主要障礙。術后3～5d，2周，1月是排斥的高發期。本病例術后5d出現急性排斥反應。

Background

Patient Mr.Yang，51years old，was hospitalized because of fourth stage silicosis and the bilateral spontaneous pneumothorax.He had the allogeneic left lung transplantation.Acute reject reaction is a main obstacle to the success in organ transplantation.Three to five days，two weeks and one month after the operation are the periods that acute reject reaction occurs mostly.In this case it occurred on the 5th day after his operation.

交流

（病人正準備進餐，護士小王發現他眉頭微皺）

護士：怎么了？老楊，有什么不舒服嗎？

病人：我沒胃口，而且胸口有點悶。

護士：（檢查氧氣裝置）是嗎，吸氧管道都很通暢。（發現病人呼吸稍急促，并咳嗽，協助其輕拍背部。監護儀顯示心率加快，氧飽合度下降）

護士：老楊，你咳嗽沒有上午那么有力啊，來，做緩慢深腹式呼吸。（做示范，同時通知醫生）

病人：是啊。我現在覺得全身沒力氣。

護士：不著急。（輕拍病人手背給予安慰）

（醫生檢查后確定為急性排斥反應，遵醫囑馬上給予甲強龍500mg靜脈推注。）

病人：小王，我早上感覺蠻好，怎么突然出現這種情況，（停頓一下，神情緊張）是不是發生了排斥反應？

護士：你手術前一定查看了一些肺移植手術的有關資料吧？

病人：是啊。

Interactions

（The patient was preparing to have dinner.Nurse Wang noticed his wrinkled eyebrow and seemed very unhappy）

Nurse：What's the matter，Mr.Yang？Feeling uncomfortable？

Patient：I have no appetite and feel stuffy in the chest.

Nurse：（checking the oxygen device）Really？The tubes of the oxygen inhaler are not obstructed.（Found that the patient's respiration are little fast and the patient is coughing，she pats his back to help him.The monitor shows that the patient's heart rate is accelerated and the SpO2is dropping.）

Nurse：Mr.Yang，you don't cough as strong as you did this morning.Come and take an abdominal respiration slowly and deeply.（Performs the demonstration and notify the doctor at the same time）

Patient：Yes，I have no strength.

Nurse：Take it easy.（Lightly pat the back of the patient's hands to comfort him）

（After examining the patient，the doctor determined that it was acute rejection.500mg ethylprednisolone mainline is injected intravenously at once.）

Patient：Miss Wang，I feel quite good this morning.What is happening now？（pause for a minute，a little nervous）Is it the reject reaction？

Nurse：You must have read some literature about lung transplantation before your operation，haven't you？

Patient：Yes，I have.

（卜麗芬）