從心開始－－心臟移植病人之評估與處置

New Life from the Heart: Assessment and Management of Heart Transplant Patients

心臟衰竭末期病人接受心臟移植手術後可獲得正常的心臟功能，享受延長的生命。然一個心臟移植手術，手術前、中、後期的治療與照顧皆扮演著重要的角色。術前捐贈者及受贈者的審慎評估、移植器官的保存，手術中特殊的手術技巧與步驟、及術後使用免疫抑制劑並且要預防感染與排斥的發生，使心臟移植病人的照護相較其他心臟手術更顯複雜。對於心臟移植手術病人心臟功能的恢復、感染及排斥等合併症，需仰賴具有專業知識和臨床技術的醫護人員來評估及判斷病人的狀況，及早發現相關合併症的產生，並給予適切的照護。此篇文章藉由臨床照護經驗，配合心臟移植的相關文獻，針對心臟移植手術病人醫療評估與處置、及術後相關照護做一介紹，提供醫護人員於心臟移植手術病人照護時之參考。

Patients who receive heart transplantation surgery following end-stage cardiac failure benefit from efforts to improve their post-surgical quality of life. Assessing and managing perioperative care play an important role in heart transplantation. Evaluations of donor and recipient should be conducted carefully and recommended candidates should by vetted by a qualified heart transplantation committee. The operative procedure is different from general cardiac surgery, and organ preservation is a key step in linking the donor to the recipient. Postoperative infection control and administration of immunosuppressive agents further affect the outcome of heart transplantation. Based on a review of articles and our clinical care experience, we focus on the assessment and the management of heart transplantation in this article.