1例小肠移植的术后观察与护理

Observation and nursing for a case of small intestine transplantation

目的探讨小肠移植治疗短肠综合征和终末期肠功能衰竭的护理。方法 2008年5月23日天津市第一中心医院开展首例小肠移植术。小肠移植术中,采用供体肠系膜上动脉、静脉分别与受体腹主动脉、肠系膜上静脉吻合。留置肠内减压管,供体肠段上端与受体十二指肠侧侧吻合,供体肠段下端与降结肠侧侧吻合同时供体肠段下端行腹壁造瘘。结果术后3周出现肠段狭窄,同时患者出现混合性感染。经过营养支持、抗排斥反应、控制感染,患者体温下降。患者术后仍需持续静脉营养支持治疗,采用他克莫司(FK506)静脉泵入抗排斥治疗。结论护理工作主要在于细致、严格地执行复杂的日常治疗,严格控制静脉营养液体输入速度、温度,注意营养液体的稳定性。术后病理检查依赖于造瘘口的通畅,通过对造瘘口的观察也可判定肠管状态。患者术后应实行严密隔离,遵循严格操作流程控制感染,也应注意患者个人卫生的处理。

Objective To investigate nursing of small intestine transplantation therapeutic treatment for short bowel syndrome and end-stage bowel diseases. Methods The first small intestine transplantation in Tianjin First Center Hospital was performed on May 23rd 2008. During the small intestine transplantation,the superior mesenteric artery and the superior mesenteric vein of donor small intestine segment were anastomosed to the recipient's abdominal aorta and superior mesenteric vein respectively. A drainage tube was placed insider the donor intestine segment. The upper end of graft was anastomosed to the recipient's duodenum,while the infer end anastomosed to colon. All the anastomoses were performed by the side-side method. And a fistulization was made at the infer end of graft. Results Several strictures were found inside the lumen of graft,3 weeks after the operation. The patient also suffered from poly infection at the same time. Intravenous nutritional support,anti-rejection,anti-infection treatments were given. The body temperature of patient came down. FK506 solution was given by intravenous injection pump as an immune suppression therapy. Conclusions Nurses are facing more complicated daily treatments of intestine transplantation patient. More attentions should be paid to the temperature,stability of nutrient solution and the speed of instillation. The stoma was very important for biopsy. We can also find some information of graft from the stoma. Strict isolation,rigorous procedures and personal hygiene of patient are very important for preventing infections.