活体小肠移植受者多学科协作护理方案的制订及应用

Development and application of a multidisciplinary nursing program for recipients of living small bowel transplantation

目的制订活体小肠移植受者多学科协作护理方案,并评价其临床应用效果。方法组建多学科协作团队,针对活体小肠移植的护理难点,查阅指南、操作规范及相关文献,制订多学科协作护理方案,包括营养管理、感染预防和控制、排斥反应监测、免疫抑制、康复运动、心理干预及延续性照护。选取2019年8月—2020年3月在浙江省某三级甲等医院移植中心接受亲属活体小肠移植的6例成人受者作为应用对象,实施多学科协作护理方案,并评价其术后康复情况。结果本组共6例亲属活体小肠移植受者,其中1例受者术后腹水培养提示屎肠球菌感染,经积极干预后感染得到控制;急性排斥反应发生率为0。6例受者病情稳定,移植肠功能恢复良好,顺利出院,并于术后3个月内如期完成造口回纳术。出院后随访依从性达100%;他克莫司血药浓度控制良好。结论应用多学科协作护理方案可降低并发症的发生,加速术后康复进程,并确保活体小肠移植受者从医院到家庭这一过渡期的安全性。

Objective To develop a multidisciplinary nursing program for recipients of living small bowel transplantation and to evaluate its effectiveness. Methods A multidisciplinary team was set up,consulting the guidelines,operation specifications and related literature according to the nursing difficulties. A multidisciplinary nursing program was developed,including nutrition management,infection prevention and control,rejection monitoring,immunosuppression,rehabilitation exercise,psychological interventions and continuous care. 6 adult recipients of living small bowel transplantation admitted to a level A tertiary hospital from August 2019 to March2020 were selected, to carry out a multidisciplinary nursing program and to evaluate their postoperative rehabilitation. Results Among 6 recipients in this group,1 case was diagnosed enterococcus faecium infection with ascites culture. The infection was controlled after active interventions,and there was no acute rejection case. The 6 recipients were discharged from the hospital after their condition was stable,and the stoma was completed as scheduled within 3 months after the operation. The follow-up compliance after discharge reached 100%;blood drug concentration was well controlled. Conclusion The application of the multidisciplinary nursing program can reduce the incidence of complications,accelerate the process of postoperative rehabilitation,and ensure the safety of recipients during the transition period from hospital to family.