安徽省首例成人活体肝移植的医护一体化管理  

Doctor-nurse integrated management in the first case of adult living donor liver transplantation in Anhui Province

作　　者：张玲[1] 胡静荣 余孝俊[1] 赵红川[1] 耿小平[1] ZHANG Ling;HU Jingrong;YU Xiaojun;ZHAO Hongchuan;GENG Xiaoping(Department of Organ Transplantation,Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230001,China)

机构地区：[1]安徽医科大学第一附属医院器官移植肝胆胰外科,安徽合肥230001

出　　处：《中华全科医学》2024年第3期389-392,417,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金青年基金项目(81702829)。

摘　　要：目的 总结安徽省首例成人成功活体肝移植的康复管理经验。方法 2021年12月安徽医科大学第一附属医院器官移植肝胆胰外科成立医护移植专科小组,对肝移植供体、受体移植评估期、围手术期、居家管理期3个阶段实施医护一体化精准管理。移植评估期从解剖学、生理学和社会心理学3个方面进行医护一体化的综合评估与干预,尤其在活体肝移植中需获得二级伦理委员会审批同意手术,做好肝移植供体和受体两方面的整体评估方可进行手术,为手术成功奠定基础;围手术期除外科围手术期常规措施外,从术前准备、免疫抑制药物精细化管理、移植器官功能监测、保护性隔离与感染防控、优化快速康复管理策略5个方面进行全面细致化的治疗与护理,是供体、受体顺利康复的关键;居家管理期医护协作通过各种干预提升受者的自我管理效能水平,促使患者采取健康行为,运用血药浓度监测法、药片计数法以及问卷调查法追踪肝移植受体居家期间服药依从性,并优化术后复查流程。结果 肝移植供体、受体手术顺利,肝移植供体于术后第11天康复出院,肝移植受体于术后第18天康复出院,肝移植供体、受体血生化指标提示肝功能良好,免疫抑制剂血药浓度维持在理想水平,肝移植供体残肝和肝移植受体供肝均增生满意。居家管理期间密切随访,术后8个月供体、受体均恢复良好。结论 成人活体肝移植手术需要医护团队密切合作,以严谨的态度、高质量的管理,实施精准的诊疗护理措施,从而获得供体、受体双方的满意恢复。Objective To summarize the experience in rehabilitation management in the first case of adult living donor liver transplantation in Anhui Province.Methods The doctor-nurse integrated group was established in the Department of Organ Transplantation,Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Anhui Medical University in December 2021.The doctor-nurse integrated management consisted of precise care in three courses:preoperative evaluation stage,perioperative period and domestic management period of both of the liver transplant donor and recipient.During the preoperative evaluation period of transplantation,comprehensive assessment and intervention of medical care integration were carried out from three aspects:anatomy,physiology and social psychology.The living donor liver transplantation must be especially approved from the senior ethics committee.A precise overall evaluation of both the donor and the recipient is a cornerstone in a successful living donor liver transplantation.In addition to routine perioperative care during the perioperative period,a good recovery of both the donor and the recipient is dependent on the following five aspects:adequate preoperative preparation,refined care in immunosuppressive drugs management,monitoring of transplanted organ function,protective isolation in case of infection prevention,and optimization of rapid recovery management strategies.During the domestic care course,various nursing interventions were used to improve the self-efficacy level of the recipients,to encourage patients to adopt healthy behaviors,to optimize the postoperative examination process and to track the drug compliance by monitoring the blood drug concentration,counting tablet and collecting questionnaire survey.Results Both donor and recipient underwent successful operations.The donor recovered well and was discharged from the hospital 11 day after operation and the recipient was discharged on the 18th day with satisfied recovery.The blood biomarkers of both the donor and the

关 键 词：肝癌 成人 活体肝移植 医护一体化管理 

分 类 号：R735.7[医药卫生—肿瘤] R73-35[医药卫生—临床医学]