肺移植治疗65岁及以上终末期肺病患者的护理体会

Nursing experience of lung transplantation in the treatment of 65 years and above patients with terminal lung disease

目的探讨肺移植治疗老年（≥65岁）终末期肺病的护理体会。方法总结接受肺移植治疗的24例老年终末期肺病患者的护理经验。结果24例患者术后1、2、3、5年总体存活率分别为74．2％（67．4％和87．8％）、68．8％（61．5％和87．8％）、57．9％（53．8％和70．6％）、39．6％（40．2％和35．7％），单、双肺移植生存期无统计学差异（P〉0．05）。术后11例死亡，包括感染6例、原发性移植物失功（PGD）1例、急性排斥反应（AR）1例、闭塞性细支气管炎（BOS）2例、心力衰竭1例。术后患者肺功能较术前显著改善（P〈0．01），但随访1～2年后，双肺移植组效果更好。结论单、双肺移植均是治疗老年终末期肺病的有效方法，术后可延长患者生存时间、改善生活质量，密切的医护配合是成功的关键。

ObjectiveTo explore nursing experience of lung transplantation in the treatment of 65 years and above patients with terminal lung disease. Methods Nursing experience of lung transplantation in the treatment of 24 patients with terminal lung disease was summarized. Results There were 24 patients in total with 16 single lung patients and 8 double lungs patients in the research. Overall survival rates of 24 patients were 74.2 %, 68.8 %, 57.9 % and 39.6 % in the first, second, third and the fifth postoperative year respectively, and survival rates of single and double lungs patients were respectively 67.4 % and 87.8 % in the first year, 61.5 % and 87.8 % in the second year, 53.8 % and 70.6 % in the third year and 40.2 % as well as 35.7 % in the fifth year. Thus, the difference was not statistical significant （P 〉0.05）. There were 11 patients dead including infection in 6 patients, acute rejection （AR） in 1 patient, obstructive bronchiolitis（BOS） in 2 patients and heart failure in 1 patient. Postoperative lung function of patients was significantly improved compared with preoperative condition （P 〈0.01）, but followed- up visits revealed that effect of double lung transplantation group is better in 1 to 2 years. Conclusion Single or double lung transplantation is effective methods to treat the elderly patients with terminal lung disease. The operation can prolong the survival time and improve the quality of life of patients, and close nursing is the key to success.