一位行血型不相容肝臟移植術後病人之照護經驗

An experience of caring for a patient who underwent ABO-incompatible living-donor liver transplantation

本文描述一位因酒精性肝硬化病人行血型不相容活體肝臟移植手術之照護經驗，護理期間為2022年3月15日至2022年3月24日，護理過程中藉由觀察、會談、直接照護等方式收集資料，並運用Gordon十一項健康功能型態進行整體性評估，確立個案有潛在危險性感染、知識缺失、個人因應能力失調之健康問題。肝臟移植手術是治療及延續生命的方式，從術前評估、決定手術到移植術後，過程艱辛漫長，不論是個案或家屬，在生理、心理或面對日常照護皆是挑戰，故成為筆者選案動機。照護過程中提供整體及連續性照護，透過建立良好護病關係，鼓勵個案說出內心感受及想法，針對術後照護及後續日常照護予採漸進式及持續性衛教，了解並針對問題即時澄清、提供衛教手冊，運用口訣連結物品及圖片記憶，使個案能夠了解及正確執行日常生活照護。臨床之血型不相容肝臟移植案例有逐漸增加趨勢，建議針對血型不相容相關照顧設立定期舉辦讀書會及跨領域醫護聯合討論會，以及設立衛教資料便於臨床之應用，期望藉此篇照護經驗之分享，提供日後護理人員臨床照護參考。

This study presents the experience of caring for a patient who underwent ABO-incompatible (ABOi) living-donor liver transplantation for alcoholic cirrhosis. The care period extended from March 15 to March 24, 2022. During this time, data were collected through observation, interviews, and direct care. A comprehensive assessment was conducted using Gordon’s 11 functional health patterns, and the following major health problems were identified: risk of infection, deficient knowledge, and ineffective individual coping. Liver transplantation is a life-prolonging treatment, yet the process—from preoperative assessment and surgical decision-making to postoperative recovery—poses significant physical, psychological, and daily-care challenges for both the patient and their family. These challenges served as the primary motivation for this study. In this case, holistic and continuous nursing care was provided. A strong therapeutic nurse–patient relationship was established to encourage the patient to express their inner feelings and concerns. Progressive and ongoing health education was delivered throughout the postoperative period and during daily follow-up care. This included timely responses to the patient’s questions, provision of health education manuals, and instruction in mnemonic strategies to help the patient retain and correctly apply care-related knowledge in everyday life. Given the increasing number of patients undergoing ABOi living-donor liver transplantation, it is recommended that interdisciplinary study groups and nurse–physician forums on ABOi care be held regularly. Additionally, accessible and standardized health education materials should be provided for clinical staff. By sharing this care experience, the study aims to serve as a reference for nursing personnel involved in future clinical practice.