照護一位異體手移植病人之加護護理經驗

A Nursing Experience of Allogeneic Hand Transplantation

本文主要探討異體手部移植術後在加護病房照護經驗，病人接受異體手部移植手術所面臨之生理及心理相關照護。筆者於2019年12月4日至12月11日照護此病人。藉由身體評估、觀察、傾聽、會談及臨床症狀收集資料，以生理、心理、社會及靈性面向進行整體性評估，確立病人有組織灌流改變、潛在性移植排斥、焦慮及知識缺失之護理問題。加護病房照護期間首重維持正常組織灌流，避免急性排斥及免疫治療之副作用，除此之外藉由傾聽、會談等方式引導病人表達因身體活動限制而導致焦慮的感受，除衛教病人移植後照護重點、共同擬參予治療計畫外，協助病人完成部分自我照護，增加病人控制感並給予正向鼓勵。經由手移植團隊努力照護下，病人順利轉至病房，有鑒於目前異體手部移植術後照護相對罕見，希望藉由此篇文章，分享手移植在加護病房照護相關經驗，建議可制定手移植照護流程，可使醫護人員臨床照護有遵循之依據，亦可提升照護品質。

This article described a postoperative in intensive care unit care experience of Allogeneic Hand Transplantation, which included the potential physiological, psychological, and other related nursing issues resulted from the transplantation. The period of nursing care was from December 4th to December 11th, 2019. Data were collected from physical assessment, observation, listening, interviews, and clinical symptoms to evaluate his physical, psychological, social, and supirtual health. Primary nursing problems included impaired tissue integrity, potential transplant rejection, anxiety, knowledge deficit. During the nursing in the intensive care unit, the first priority was to maintain normal tissue perfusion and avoid the side effects of acute rejection and immunotherapy. In addition, listening, interviews and other methods were used to guide the patient to express their anxiety due to physical activity restrictions, except for health education patients after transplantation. In addition to the focus of care was let the patient participate in the treatment plan, assist part of the self-care completely, increase sense of control and encourage positively. After the care of the hand transplant team, the patient was transferred to the ward smoothly. Through this article, I hope to share the experience of hand transplantation in the intensive care unit.