器官移植的护理课件.pptVIP

2005/09/12 Nursing management of clients with Organ Transplantation 長庚大學 護理系 翁麗雀 Review of History 年代 事項 西元前 扁鵲 心臟互換(列子湯問篇) 心臟陰陽失調 1946 發現移植失敗是因免疫 1953 腎移植成功(Hume, Hamburger, Murray諾貝爾 醫學獎) 1959-1962 淋巴器官做放射線治療 1962 Murray use Imuran 1963 Starzl use Imuran+prednisolone 1962 Hamburger: Tissue typing 1966 Kissmeyer: Crossmatch 1973 Opelz Terasaki: 移植前輸血 1978 Ting Morris: HLA-DR 1978 Calne Use cyclosporine 1967 Barnard: Heart transplantation 1968 李俊仁 第一例腎移植 1984 台灣 腦死即死亡 1984 陳肇隆 第一例肝臟移植 1984 第一例胰臟移植(IDDM) 1987 朱樹勳 心臟移植 1988 胚胎腦移植應用到人體 1989 澳洲 首例活體肝移植 199-- 陳肇隆 活體肝移植 2000 基因轉殖技術 2004 不同血型的移植 (plasmapheresis) Criteria for transplantation The presence of end-stage disease in a transplantable organ Failure of conventional therapy to treat the condition Progression of problems associated with the organ failure which in themselves may be fatal The absence of disease that would attack the transplanted tissue The absence of untreatable malignancy or irreversible infection Ability of the clients to survive the surgical procedure 移植的適應症及禁忌症(以肝臟移植為例) 適應症 不可逆性末期慢性肝病 先天性膽道閉鎖 Wilson disease(銅代謝異常) 原發性肝硬化 猛爆性肝炎 肝臟惡性腫瘤局限在肝臟 禁忌症 絕對禁忌 肝膽系外的活動性感染 肝膽系的轉移性癌 末期心肺疾病 AIDS 相對禁忌 年齡在60歲以上 末期腎病 Donor procurement and preparation 活體Living donor : liver (adult to child，adult to adult), renal, bone marrow, cornea…….. 屍體Cadavers : heart, liver, pancreas, cornea, skin, bone , lung, small bowel United Network for Organ Sharing (UNOS) 財團法人器官捐贈移植登錄中心 器官保存：Cadavers organ preserved at 4℃ electrolyte solution warm ischaemic and cold