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題名 | 一塵肺症接受肺臟移植後患者之物理治療介入--病例報告=Physical Therapy after Lung Transplantation in a Patient with Pneumoconiosis |
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作者 | 蕭淑芳; 吳英黛; 李元麒; 陸希平; 張逸良; Hsiao, Shu-fang; Wu, Ying-tai; Lee, Yung-chie; Luh, Shi-ping; Chang, Yih-leong; |
期刊 | 中華民國物理治療學會雜誌 |
出版日期 | 19971000 |
卷期 | 22:4 1997.10[民86.10] |
頁次 | 頁299-308 |
分類號 | 418.996 |
語文 | chi |
關鍵詞 | 塵肺症; 肺臟移植; 物理治療; Pneumoconiosis; Lung transplantation; Physical therapy; |
中文摘要 | 塵肺症(pneumoconiosis)是一種由於吸入空氣中大量粉塵,所造成的不可回復性 (irreversible) 的肺疾病,塵肺症一旦發生並無根治方法,當保守支持性療法失敗時, 患 者通常會死亡於感染、呼吸衰竭。肺臟移植是這些末期病人的最後希望,目前北部地區的肺 臟移植已有 12 例,文中病例是 60 歲的男性病人因職業性塵肺症接受單肺移植,其病史長 達十多年,除右肺纖維化外,胸腔壁肌肉也有明顯萎縮,呼吸肌無力,因此活動度低,體適 能差。肺功能檢查顯示為中等程度的限制型換氣缺損,合併嚴重的阻塞型換氣缺損及中等程 度的擴散障礙 (moderate impairment of diffusing capacity)。於 85 年 10 月 19 日進 行右肺移植,術後第五天起照會物理治療。物理治療計劃在加護病房內強週維持肺部清潔, 開始活動病人及預防併發症,在普通病房期間則為積極的心肺功能訓練。移植術後肺功能與 心肺耐力都有增加,日常生活大部份可自行完成,在 6 分鐘行走測試的距離為 230 公尺, 並可上下一層樓梯,中途只需休息一次。術後進行物理治療時需克服其相關之合併症,包括 因移植引起之肺臟生理變化、傷口疤痕沾黏、藥物相關之副作用、與感染問題。其治療原則 與一般胸腔手術後相同, 但應注意感染控制與病人情況藉以調整治療計劃。 (中華物療誌 1997;22(4):229-308 ) |
英文摘要 | Pneumoconiosis is an irreversible lung disease. After conservative treatment was all failed, patients usually died from infection and respiratory failure. Lung transplantation is the only hope for these terminal-stage patients. This 60-years-old male patient has suffered from pneumoconiosis for more than 10 years. Pre-operative examination revealed right lung destruction and fibrosis, chest wall muscle atrophy, low activity level, and poor fitness. Moderate restrictive ventilatory defect, severe obstructive ventilatory defect, and moderate impairment of diffusing capacity were demonstrated by his pulmonary function test. He received right single lung transplantation on Oct. 19, 1996. Five days later, physical therapist was consulted for chest care and reconditioning. In intensive care unit, physical therapy programs were emphasized on improving lung hygiene, mobilizing the patient, and preventing complications. After the patient was transferred tjo general ward, programs continued and focused on intensive cardiopulmonary function training. In general, this patient got much improvement both in lung function and daily activities after lung transplantation. Physical therapy program in post-lung transplantation care was similar with other thoracic surgery but much longer to reach the treatment goal. Therapists have to understand the course and the related conditions, such as the compliance of the chest wall, the physiological difference of the transplanted lung, side effects of medications, and signs or symptoms of rejection and infection. Treating the patient as a whole man, monitoring patient's major systems and modifying treatment program accordingly are the most important guidelines for such patients.(JPTA ROC 1997;22(4):299-308) |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。