照護首例手臂異體移植病人之護理經驗

A Nursing Experience of Allogeneic Arm Transplantation

鍾雅惠(Ya-Hui Chung)；林怡君(Yi-Chun Lin)；張蘭芬(Lan-Fen Chang)；湯婉孏(Wan-Lan Tang)

手臂異體移植 ； 移植術後照護 ； 身體心像紊亂 ； allogeneic arm transplantation ； body image disturbance ； post-transplant care

志為護理-慈濟護理雜誌

17卷2期（2018 / 04 / 01）

118 - 128

繁體中文

本文主要探討手臂異體移植術後在單一病例之護理經驗，包括因接受移植手術所可能面臨的生理、心理與相關照護問題。作者於2014年9月3日至9月8日照護該名病人。透過相關病史、病人入院會談等方式收集資料，再以Gordon十一項健康功能型態做整體評估，確立病人有潛在危險性感染、潛在危險性損傷、身體心像紊亂及照顧者角色緊張等護理問題。個案在護理人員陪伴下，逐步加強照護的衛教，如日常照護、飲食、服藥與併發症，協助復健療程，分享國外成功案例，以增強病人信心並願意合作，讓移植體發揮最大功能。經由團隊的努力，病人終於順利出院，冀望藉由此文，分享醫護人員照顧此類病人。

This article described a postoperative care experience of a single case of arm allotransplantation, which included the potential physiological, psychological, and other related nursing issues resulted from the transplantation. The nursing period lasted from September 3rd to September 8th, 2014. Data were collected via medical records, admission records, and an interview upon hospitalization. With Gordon 11 functional health patterns as framework, the patient was confirmed to have risk for infection, risk for injury, body image disturbance, and caregiver role strain. Accompanied by the nurses, the patient received health education on post-transplant daily care, diet, medication, and potential complications, as well as successful transplantation cases from overseas, to enhance the patient’s confidence and cooperation and therefore maximize the effectiveness of the transplantation. The patient was eventually discharged with the combined effort of the medical team. The author hopes to share this experience as a reference for nurses when attending to patients with similar conditions.

1. Antoni, M. H.,Lechner, S.,Diaz, A.,Vargas, S.,Holley, H.,Phillips, K.,Blomberg, B.(2009).Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer.Brain, Behavior, & Immunity,23(5),580-591.
2. Dorf, E.,Blue, C.,Smith, B. P.,Koman, L. A.(2010).Therapy after injury to the hand.Journal of the American Academy of Orthopaedic Surgeons,18(8),464-473.
3. Jaimie, T. S,Joseph, E. I,Andrew, L.(2011).The current state of hand transplantation.Journal of Hand Surgery,36(11),1862-1867.
4. Khan, M. A.,Mohan, A.,Ahmed, W.,Rayatt, S.(2010).Nursing monitoring and management of free and pedicled flaps-outcomes of teaching sessions on flap care.Plastic Surgical Nurses,30(4),213-216.
5. Lovasik, D.,Foust, D. E.,Losee, J. E.,Lee, W. P.,Brandacher, G.,Gorantla, V. S.(2011).Helping hands: Caring for the upper extremity transplant patient.Critical Care Nursing Clinics of North America,23(3),505-517.
6. Ninkovic, M.,Weissenbacher, A.,Gabl, M.,Pierer, G.,Pratschke, J.,Margreiter, R.,Brandacher, G.,Schneeberger, S.(2011).Functional outcome after hand and forearm transplantation: What can be achieved?.Hand Clinics,27(4),455-465.
7. O’Neill, J. K.,Greenwood, A. J.,Khan, U.(2010).A survey of U.K. units and a suggested protocol for free flap reconstruction of the lower limb: Follow-up and management in the first postoperative week.Journal of Reconstructive Microsurgery,26(9),601-606.
8. Petruzzo, P,Dubernard, J. M.(2011).The international registry on hand and composite tissue allotransplantation.Clinical Transplantation,2011,247-253.
9. 江懿真,紀孟鳳(2013)。照顧一位青少女肝臟移植術後病人的護理經驗。志為護理-慈濟護理雜誌，12(5)，94-104。
10. 周桂君,李明哲(2014)。腎臟移植的醫療照護現況。護理雜誌，61(4)，15-20。
11. 張瓈方,張乃文,王桂芸(2010)。身體心像紊亂之概念分析。長庚護理，21(1)，25-32。
12. 楊書瑜,蕭珮琦,楊奇旻,施伯淳,周偉倪,楊育昇(2013)。手掌嚴重機器壓碎傷患者執行鼠蹊部皮瓣移植之職能治療介入。臺灣職能治療研究與實務，9(2)，140-146。
13. 葉英堃,文榮光,胡海國,吳就君(1977)。腎臟移植的精神醫學觀。當代醫學，4(12)，103-106。
14. 詹淑雅,劉芹芳,金繼春(2011)。身體心像紊亂之概念分析。新臺北護理期刊，13(1)，63-72。
15. 劉雪娥（校閱）(2016).成人內外科護理上冊.臺北市:華杏.

1. 黃惠珠,彭宥慈(2022)。照護一位手臂異體移植病人之護理經驗。新臺北護理期刊，24(2)，119-127。
2. 黃惠珠,徐淑芬,林秀如,沈永釗(2021)。照顧單臂異體移植個案之護理經驗。志為護理-慈濟護理雜誌，20(5)，111-121。
3. 黃弋俽,施孟綾(2023)。照護一位異體手移植病人之加護護理經驗。彰化護理，30(1)，145-156。
4. 徐惠蘋(2022)。新生命新適應：腎臟移植者心理與社會適應之詮釋。臺灣社會工作學刊，25，1+3-50。
5. 張耀文,范姜玉芬,李淑秋,朱美玲(2023)。照顧一位壞死性筋膜炎個案之護理經驗。長庚護理，34(1)，91-101。