1例二次肺移植患儿的护理

Nursing care for a child underwent lung retransplantation

总结1例造血干细胞移植术后发生肺排斥反应行双肺移植术,且在肺移植术后并发闭塞性细支气管炎行二次肺移植患儿的护理经验。护理要点:实施阶梯式侧卧位和俯卧位交替的无创机械通气,改善肺功能;采用序贯式气道廓清,控制肺部感染;给予精准的容量管理,预防肺水肿;加强病情观察及用药管理,预防医院感染及排斥反应;提供目标导向的个性化营养支持,改善营养状况;落实心理护理措施,提升治疗信心及依从性;加强健康教育及随访管理,改善长期生存质量。经积极救治与精心护理,患儿术后26 d康复出院。

To summarize the nursing experience of a child with pulmonary rejection after hematopoietic stem cell transplantation who underwent double lung transplantation and was complicated with bronchiolitis obliterans after lung transplantation and underwent second lung transplantation.The key points of nursing included:the implementation of step-wise lateral position and prone position alternate non-invasive mechanical ventilation to improve lung function;sequential airway clearance was used to control pulmonary infection;precise volume management to prevent pulmonary edema;to strengthen the observation and medication management,prevent hospital infection and rejection;to provide goal-oriented personalized nutritional support to improve nutritional status;psychological nursing measures were implemented to improve the treatment confidence and compliance of children;health education and follow-up management should be strengthened to improve the long-term quality of life.After active treatment and careful nursing,the child recovered and was discharged 26 days after surgery.