自體免疫肝炎病人面臨肝臟移植評估之護理經驗

Nursing experience of a patient with autoimmune hepatitis who underwent liver transplantation

10.6692/KJN.202005/SP_37.0005

呂佩瑾(Pei-Jin Liu)；連靜雯(Ching-Wen Lien)；塗勝翔(Sheng-Hsiang Tu)；溫明寰(Ming-Huan Wen)

自體免疫性肝炎 ； 肝衰竭 ； 肝臟移植 ； Autoimmune hepatitis (AIH) ； liver failure ； liver transplantation

高雄護理雜誌

37卷增訂刊（2020 / 05 / 01）

48 - 61

繁體中文

自體免疫性肝炎（autoimmune hepatitis, AIH），相對於病毒性或酒精性肝炎等，較難被發現與診斷，常呈現肝衰竭後才確診，需肝臟移植才得以救命。本文描述一位年輕女性，罹患自體免疫性肝炎併發急性肝衰竭，面臨危及生命且不易尋求肝臟捐贈者的困境。以Gordon 11項功能性健康型態進行評估，歸納有體液容積過量、睡眠型態紊亂、無力感及家庭因應能力失調等健康問題。護理過程措施包含低鹽飲食與限水計畫，改善腹水腹脹不適；以音樂療法、穴位按壓與芳香療法，緩解睡眠型態紊亂；運用陪伴與傾聽，正向鼓勵，增加自我照護機會，降低無力感，且因AIH疾病特性，尋求捐贈者較為困難，須建立良好互信之護病關係，協助個案與醫療團隊溝通，並幫助其成功尋求捐贈者，以共同完成移植手術。

Autoimmune hepatitis (AIH), compared with viral or alcoholic hepatitis, is difficult to be discovered and diagnosed, but is often diagnosed when liver failure occurs, with the only ultimate treatment for liver failure being liver transplantation. This article describes a young woman who suffered from autoimmune hepatitis with acute liver failure. She was in a life-threatening condition at that time and could not find liver donors. Based on Gordon's 11-item Functional Health Assessment, the patient's health problems were identified as the following: excess fluid volume, disturbed sleep pattern, powerlessness, and disabled family coping. The nursing care process included low-salt diet and water-restriction plan to improve abdominal distension and discomfort; music therapy, acupressure and aromatherapy to alleviate sleeping disorders; and accompanying the patient during their difficult time, as well as enhancing self-care activities to reduce powerlessness. As it is difficult to seek donors due to the nature of AIH disease, it is necessary to establish a good mutual-trust relationship, assist in communicating with the medical team, and help the patient successfully find donors to complete the liver transplantation.