护患情境会话

单肺移植急性排斥反应病人的护理

Nursing Care for a Patient with Acute Rejection after a Single-Lung Transplant

背景

病人杨先生，51岁。因IV期矽肺，双侧自发性气胸而入院。行左侧肺同种异体肺移植术。急性排斥反应为器官移植成功的主要障碍。术后3～5d，2周，1月是排斥的高发期。本病例术后5d出现急性排斥反应。

Background

Patient Mr.Yang，51years old，was hospitalized because of fourth stage silicosis and the bilateral spontaneous pneumothorax.He had the allogeneic left lung transplantation.Acute reject reaction is a main obstacle to the success in organ transplantation.Three to five days，two weeks and one month after the operation are the periods that acute reject reaction occurs mostly.In this case it occurred on the 5th day after his operation.

交流

（病人正准备进餐，护士小王发现他眉头微皱）

护士：怎么了？老杨，有什么不舒服吗？

病人：我没胃口，而且胸口有点闷。

护士：（检查氧气装置）是吗，吸氧管道都很通畅。（发现病人呼吸稍急促，并咳嗽，协助其轻拍背部。监护仪显示心率加快，氧饱合度下降）

护士：老杨，你咳嗽没有上午那么有力啊，来，做缓慢深腹式呼吸。（做示范，同时通知医生）

病人：是啊。我现在觉得全身没力气。

护士：不着急。（轻拍病人手背给予安慰）

（医生检查后确定为急性排斥反应，遵医嘱马上给予甲强龙500mg静脉推注。）

病人：小王，我早上感觉蛮好，怎么突然出现这种情况，（停顿一下，神情紧张）是不是发生了排斥反应？

护士：你手术前一定查看了一些肺移植手术的有关资料吧？

病人：是啊。

Interactions

（The patient was preparing to have dinner.Nurse Wang noticed his wrinkled eyebrow and seemed very unhappy）

Nurse：What's the matter，Mr.Yang？Feeling uncomfortable？

Patient：I have no appetite and feel stuffy in the chest.

Nurse：（checking the oxygen device）Really？The tubes of the oxygen inhaler are not obstructed.（Found that the patient's respiration are little fast and the patient is coughing，she pats his back to help him.The monitor shows that the patient's heart rate is accelerated and the SpO2is dropping.）

Nurse：Mr.Yang，you don't cough as strong as you did this morning.Come and take an abdominal respiration slowly and deeply.（Performs the demonstration and notify the doctor at the same time）

Patient：Yes，I have no strength.

Nurse：Take it easy.（Lightly pat the back of the patient's hands to comfort him）

（After examining the patient，the doctor determined that it was acute rejection.500mg ethylprednisolone mainline is injected intravenously at once.）

Patient：Miss Wang，I feel quite good this morning.What is happening now？（pause for a minute，a little nervous）Is it the reject reaction？

Nurse：You must have read some literature about lung transplantation before your operation，haven't you？

Patient：Yes，I have.

（卜丽芬）