一位肺臟移植術後併發過度動態性呼吸道塌陷病人之加護經驗

Chia-Yu Li; Hsiu-Jung Hsieh

doi:10.6142/VGHN.202406_41(2).0005

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P138 - 146

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6142/VGHN

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一位肺脏移植术後并发过度动态性呼吸道塌陷病人之加护经验

Nursing Experience of a Patient in Excessive Dynamic Airway Collapse After Lung Transplant

李家语(Chia-Yu Li) ；谢秀容(Hsiu-Jung Hsieh)

荣总护理； 41 卷 2 期 (2024 / 06 / 01) ， P138 - 146

繁体中文;英文 DOI： 10.6142/VGHN.202406_41(2).0005

肺移植；过度动态性呼吸道塌陷；湿化高流量氧气治疗；术後急性谵妄； ABCDEF组合照护模式； lung transplant ； excessive dynamic airway collapse ； high flow nasal cannula oxygen therapy ； delirium ； ABCDEF bundle care

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摘要 │ 参考文献 (13)

摘要〈TOP〉

并列摘要〈TOP〉

This article describes the nursing care for a patient with excessive dynamic airway collapse after lung transplant. Data regarding the patient's health condition were collected from December 18, 2021, to April 18, 2022, through direct observation, interviews, reviews of medical records, and physical assessment. The author conducted a comprehensive four-facet assessment, encompassing physical, psychological, social, and spiritual dimensions. The three primary health problems identified were acute confusion, impaired physical mobility, and ineffective breathing pattern. After lung transplant, extensive rehabilitation is necessary. However, due to preoperative respiratory failure, the patient had been bedridden for an extended period, which had led to physical activity dysfunction. The onset of delirium after the transplant interrupted postoperative physical therapy and respiratory training. Additionally, long-term intubation was complicated by excessive dynamic airway collapse, resulting in collapse of the respiratory tract and an inability to wean the patient off the respirator, leading to a suspension of the treatment plan. Consequently, the patient experienced substantial psychological and physical postoperative stress, prompting the authors to focus on this case. For acute postoperative delirium, the ABCDEF Bundle offers interventions in pain management, sedation, breathing training, physical activities, and family empowerment and has been found to effectively reduce delirium and enhance patient cognition. After lung transplant, a rehabilitation program involving early mobilization and a gradual exercise program is essential for improving cardiopulmonary function and reducing physical activity dysfunction. The rare complication of long-term intubation due to excessive dynamic airway collapse necessitated continued dependence on the respirator. However, through interventions such as humidified high-flow oxygen therapy and limb strength training to assist with posture changes, the patient was eventually successfully weaned off the respirator. This case demonstrates the efficacy of humidified high-flow oxygen therapy for patients with excessive dynamic airway collapse in facilitating respirator weaning. Furthermore, employing the ABCDEF Bundle in an intensive care setting is recommended to empower families, promote early mobilization, enhance cardiorespiratory function in critically ill patients, and improve the quality of intensive care.

参考文献 ( 13 ) 〈TOP〉

萧淑芳、萧季萱、徐绍勋、王亭贵、赖玉玫．(2021)．从术前到术後-急性骨髓性白血病後进行骨髓移植并发移植物对抗宿主疾病接受双侧肺移植个案之物理治疗介入成效报告．物理治疗，46(2)，119-120。
连结：
DeBolt, C. L., Gao, Y., Sutter, N., Soong, A., Leard, L., Jeffrey, G., Kleinhenz, M. E., Calabrese, D., Greenland, J., Venado, A., Hays, S. R., Shah, R., Kukreja, J., Trinh, B., Kolaitis, N. A., Douglas, V., Diamond, J. M., Smith, P., & Singer, J. (2021). The association of post‐operative delirium with patient‐reported outcomes and mortality after lung transplantation. Clinical Transplantation, 35(5), e14275.
连结：
Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., … Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), 825-873.
连结：
Kako, J., Morita, T., Yamaguchi, T., Kobayashi, M., Sekimoto, A., Kinoshita, H., Ogawa, A., Zenda, S., Uchitomi, Y., Inoguchi, H., & Matsushima, E. (2018). Fan therapy is effective in relieving dyspnea in patients with terminally ill cancer: A parallel-arm, randomized controlled trial. Journal of Pain and Symptom Management, 56(4), 493-500.
连结：
Kheir, F., & Majid, A. (2018). Tracheobronchomalacia and excessive dynamic airway collapse: Medical and surgical treatment. Seminars in Respiratory and Critical Care Medicine, 39(6), 667-673.
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