终末期肺病合并糖尿病患者肺移植手术前后护理

Nursing for Patients with End-stage Pulmonary Diseases and Diabetes before and after Lung Transplantation

总结27例终末期肺病合并糖尿病患者行肺移植术的护理。通过术前认真评估患者全身情况,为手术做好充分准备;术后严密观察病情,重视血糖监测及营养支持治疗,合理应用胰岛素;加强呼吸道管理,终末期肺病患者由于机体长期处于缺氧状态,代偿储备功能差,易发生气道内分泌物滞留,鼓励患者进行有效咳嗽咳痰,指导咳嗽时不过分用力,并协助患者按住伤口以减轻疼痛,为减少压迫移植肺,尽量取移植肺抬高的体位;肺移植术后的急性排斥反应与术后感染的临床症状很相似,有些排斥症状不典型,护士需熟练掌握专科知识,加以识别,同时鼓励患者积极、主动反映自身的主观感受,以便早期发现急性排斥反应并及早处理;清除感染源,控制感染;同时,加强心理护理,使其积极配合手术、治疗和护理,从而保证手术的安全性,改善预后,提高生活质量。

This paper summarized the nursing care of patients with end-stage pulmonary diseases and diabetes before and after lung transplantation.Preoperative nursing included serious evaluation of patients＇ condition and completely full preparation for the transplantation.Postoperative nursing concentrated on the blood sugar monitoring,nutritional support and rational application of insulin.Since secretions accumulated within airway frequently for patients＇ poor capability of reservation and compensation,effective cough and expectoration were essential,which was conducted in the position of elevating transplanted lung.It was indispensable for nurses to distinguish acute rejection of lung transplantation and postoperative infection and patients＇ response contributed to the early discovery of acute rejection.Psychological nursing was beneficial to the safety of the operation and the improvement of patients＇ quality of life.