器官移植患者灵性护理需求及影响因素分析

目的了解器官移植患者对护士提供灵性护理的需求及其影响因素。方法采用中文版患者对护士提供灵性照护的需求量表对120例器官移植患者进行调查。结果器官移植患者对护士提供灵性护理的需求总分为(27.65±4.17)分;多元回归分析结果显示,年龄、宗教信仰、术后生活自理能力及家庭年收入是器官移植患者灵性护理需求的影响因素(P0.05,P0.01)。结论器官移植患者对护士提供灵性护理的需求处于中等水平,年龄越小、有宗教信仰、术后生活自理能力越差及家庭年收入越低的患者灵性护理需求程度越高。应有效地评估患者的灵性困扰,更多地关注移植后患者身-心-社-灵状况并提供个性化的护理,满足患者的灵性需求。     

运用斯腾伯格理论培养护理创新人才

借鉴斯腾伯格的创造力投资理论时全面发展的护理创新人才培养进行理论研究。反思过去的护理教育，提出若忽视时学生的创新人格、创新思维和知识活化等方面的培养，将不利于培养全面发展的护理创新人才。因此提出多途径培养全面发展的护理创新人才的观点。     

肾移植围手术期的护理

器官移植在世界范围内得到广泛开展，其中以肾移植发展最迅速，在数量和质量上处于优先地位，肾移植是治疗慢性肾衰竭的一种有效手段，挽救了许多垂危的ERSD患者的生命。肾移植有自体肾移植和同种异体肾移植，作为肾移植工作的重要组成部分，肾移植护理工作也得到广泛的重视和提高，临床上施行的肾移植大多数为同种异体肾移植，我院从2000年开始做肾移植手术，已成功治愈25例患者。现将护理体会报告如下。     

全能护士库的建立与应用

目的培养一批具有全能素质的护理人才。提高医院护理应患能力。方法选拔24名护士，建立全能护士库。对其进行严格的职业素质、理论知识、操作技能等各方面的培训，并实行动态管理。结果全能护士解决了医院重大突发公共事件的救治，集中器官移植手术。急、危、重症患者的特护和患者剧增病区的人力不足问题。结论全能护士库的建立弥补了综合医院的应急护理人力资源溃乏的不足。提高了护理质量，取得了良好的经济效益和社会效益。     

同种胰肾双器官一期移植的术后护理

糖尿病合并肾功能衰竭应用常规治疗效果不佳。本文通过对1例糖尿病合并肾功能衰竭的患者施行同种胰肾双器官移植术的护理,总结了术后早期观察,引流管的护理,排斥反应的观察,抗凝期间的护理,营养护理及预防感染等经验。阐述了术后易发生静脉栓塞、胰瘘、出血及血肿等并发症,指出肺动脉栓塞是致命的主要原因,强调了术后严密观察病情的重要。     

多元文化护理用于ICU综合征的预防

ＩＣＵ综合征是ＩＣＵ监护过程中出现的临床综合征。阐述了其定义、临床表现、原因及机理。从多元文化护理的观点出发，提出了改善监护环境、减少紧张气氛、消除语言环境对患者的不良影响、做好基础护理、保障患者的睡眠、减少患者的孤独感、做好心理护理、早期发现异常及时处理、根据不同的社会结构因类实施护理九个方面的护理措施。     

运用斯腾伯格理论培养护理创新人才

借鉴斯腾伯格的创造力投资理论对全面发展的护理创新人才培养进行理论研究.反思过去的护理教育,提出若忽视对学生的创新人格、创新思维和知识活化等方面的培养,将不利于培养全面发展的护理创新人才.因此提出多途径培养全面发展的护理创新人才的观点.     

《肾移植围手术期处理操作规范(2019版)》解读

《肾移植围手术期处理操作规范(2019版)》是中华医学会器官移植学分会制定的肾移植操作规范系列之一。该规范对肾移植围术期受者一般护理、液体管理及主要内科并发症诊治原则进行了介绍。本文对规范内容进行解读,以期为肾移植围术期的治疗提供借鉴。2019年6月,由中华医学会器官移植学分会编写的《肾移植围手术期处理操作规范(2019版)》(下文简称规范)在《器官移植》杂志发表。这是中华医学会器官移植学分会第一次对肾移植围术期管理制定的指南,其目的是为了进一步规范肾移植术围术期的处理技术。本规范主要涉及肾移植围术期受者一般护理、液体管理及主要内科并发症诊治。本文将对该指南的重要内容进行进一步解读。     

小鼠器官移植模型的现状和展望

在20世纪60年代以前，无血管的皮肤移植是惟一研究移植免疫的动物模型。60年代初期，Lee等建立了大鼠器官移植模型并发展了门腔分流技术，这为临床器官移植和移植免疫学提供了研究模型。而从90年代至今，小鼠器官移植模型开始被越来越多的研究者所采用。本文就小鼠器官移植模型的发展、优点、限制以及其在移植免疫方面的特点作一综述，并对其未来的发展前景进行了评估。     

浅谈护理工作的社会性

护理工作是医疗卫生事业的重要组成部分，担负着“保存生命，减轻病痛，促进康复”的崇高职责。世界卫生组织提出了卫生保健的奋斗目标，即要从以医疗为中心转向以保健为中心，并向家庭医学方向发展。护理学也随着生物医学模人的转变人不断发展，护理事业由附属专业正向独立学科发展，护理工作范围也由单纯的疾病防治护理扩大到全社会的人群。护士的社会工作体现了护理工作具有社会性、群体性和多样性。互护理工作的社会性1．回对患者和家属的社会工作。护理工作的社会性决定了护理道德的广泛性。护理人员既要面l（IJ医院的患者，又要面向…     

腹部器官联合移植患者长期存活的临床观察

目的总结腹部器官联合移植患者长期存活的临床经验。方法我院从2001年10月至2005年1月共施行19例腹部器官联合移植术,其中胰肾联合移植6例,肝肾联合移植12例,肝胰十二指肠联合移植1例,术后随访10个月～3年8个月,分析总结腹部器官联合移植患者的原发疾病种类,长期存活的影响因素和器官联合移植的免疫学特点。结果19例患者手术均获成功,18例获随访,16例至今存活,2例肝肾联合移植患者死亡,其中1例术后1年6个月死于心肌梗死,1例术后1年1个月死于肺部巨细胞病毒感染。1例肝肾联合移植和2例胰肾联合移植患者各发生1次急性排斥反应,2例肝肾联合移植患者发生他克莫司中毒。18例患者中存活3年以上者4例,2年以上者7例,1年以上者6例,10个月以上者1例。结论腹部器官联合移植是治疗腹部两个器官衰竭的有效办法,影响患者术后长期存活的因素包括选择合适的受者,优质的供体器官,避免外科并发症,术前心肌梗死病史,免疫抑制方案和术后远期病毒感染等。腹部器官联合移植有不同于单器官移植的免疫学特点。     

医院住院患者对器官移植与捐献的意愿调查

目的了解医院住院患者对器官移植与捐献相关领域的认知情况和态度。方法通过自编调查问卷形式,以医院住院患者为对象进行问卷调查。内容包括一般信息、对器官移植与捐献的认知和态度,并分析影响器官移植和捐献、对移植和捐献关注的问题以及捐献方式的影响因素。数据结果以SPSS 18.0进行分析。结果本次调查共发放问卷1 000份,回收973份,有效问卷906份,有效率为93.1%。906份有效问卷中,788例(87.0%)患者听过器官移植,118例(13.0%)未听过器官移植;189例(20.9%)有移植亲属,717例(79.1%)无移植亲属;511例(56.4%)愿意接受器官移植,226例(24.9%)不愿意,169例(18.7%)不知道;490例(54.1%)同意器官捐献,173例(19.1%)不同意,243例(26.8%)不知道。性别因素对器官移植(P=0.299)和捐献(P=0.327)的意愿均无影响,年龄、学历、职业、是否听过器官移植及是否有移植亲属对器官移植和捐献的意愿均有影响(P<0.01)。性别因素对关于器官移植(P=0.727)和器官捐献(P=0.935)关注问题均无影响,年龄、学历、是否听过器官移植、是否有移植亲属对器官移植和捐献后关注的问题均有影响(P<0.01)。对器官移植手术最关注的问题依次为:是否有可供移植的器官占28.7%(260/906),术后生活质量占23.0%(208/906),手术风险占21.5%(195/906),手术费用占19.5%(177/906),术后排斥反应占7.3%(66/906)。器官捐献后最关注的问题依次为:捐献器官的合理应用占57.4%(520/906),亲属的态度占23.8%(216/906),捐献补偿占17.6%(159/906),其他占1.2%(11/906)。捐献方式上,403例(44.4%)愿意接受心脏死亡器官捐献(DCD),257例(28.4%)愿意接受脑死亡器官捐献,246例(27.2%)愿意接受活体器官捐献。性别、学历和职业对捐献方式有影响(P<0.05),而年龄、是否听过器官移植和是否有移植亲属对捐献方式无影响(P>0.05)。结论对器官移植宣传的不足和高昂的移植费用是制约器官移植接受率的主要因素,随着时间推移、全民教育水平的不断提高和加强对器官移植的广泛宣传,器官移植的接受率将呈现不断增高的趋势。目前医院患者普遍接受的器官捐献方式仍然是DCD。建立一个合理运作的捐献器官分配体系和适当的捐献补偿机制是促进器官捐献事业发展的关键。     

肝联合其他器官移植术后近期免疫抑制策略的方案探讨

目的探讨肝联合其他器官移植术后近期的免疫抑制策略。方法我中心于2004年至2009年共实施肝联合其他器官移植22例,其中肝肾联合移植17例,肝胰十二指肠联合移植5例。存活时间大于3个月的患者共18例,比较此类患者与单一器官移植患者术后近期排斥反应发生率和免疫抑制策略的差别。结果肝联合其他器官移植的患者术后3个月内,移植肝排斥反应发生率为5．5％;移植肾的排斥反应发生率为5．9％;其他器官没有发生排斥反应,较我中心单一器官移植排斥反应发生率低。同时,肝联合其他器官移植患者免疫抑制剂初始剂量及术后近期所需浓度均较单一器官移植低。结论肝联合其他器官移植的患者,由于移植肝对其他移植器官的免疫保护作用,排斥反应发生率低,所需免疫抑制剂初始剂量及浓度均低于单一器官移植。但肝脏对其他移植器官的免疫保护作用机制尚需进一步研究。     

Current Situation With Organ Donation and Transplantation in China: Application of Machine Learning

BackgroundChina ranks currently as one of the top countries for organ transplantation according to types, capacity, related research, quality, and quantity of procedures. However, the management systems struggle to support these practices. This study aims to review the current situation with organ donation and transplantation in China recently.MethodsData about organ donation and transplantation was collected by using web crawler technology from several news sections of representative portal websites in China. A total of 3475 documents about organ donation and transplantation were analyzed after data preprocessing. The documents were analyzed using machine learning to find out the relationship among the hot topics and their social popularity as well as to explore the dominant subtopics of the hot topics.ResultsThe results of weighted correlation network analysis and documents clustering analysis identified 9 topics about organ donation and transplantation in China with a wide discussion: transplantation ethics, donor compensation, use of the remains, transportation guarantee of living organs, organ allocation, relevant national standards of organ donation and transplantation, legislation on organ donation, penalties for violation, and the Red Cross Society of China.ConclusionsThis study found out the main problems and proposed them for future discussion with organ donation and transplantation system in China: the lack of publicity and education and the difficulty of standardizing legislation about ethical issues arousing ethical problems; the need to understand the relationship and the standardization among costs, expenses, and compensation; and the lack of more support from the government and public to ensure regular organ donation and transplantation.     

Organ transplantation laws in Asian countries: a comparative study

Legal tools are a necessity in organ procurement to allow transplant surgeons to remove organs from potential sources. In some countries the organ transplantation law may not only increase the organ retrieval rate, but may also decrease the number of transplantations. Reassessing the impact of organ transplantation laws on the application of transplant technology is therefore an emerging issue. This article discusses organ transplantation laws in eight Asian countries: Japan, Korea, India, Iran, Philippines, Saudi Arabia, Singapore, and Turkey. The organ transplantation laws of each of these countries were compared in terms of how they address the issues of definition of death; donor consent; the role of family and surrogate decision making; age limitation for organ donation; organ trade and donor compensation; and the organ procurement model.     

数据之美——聚焦全球器官捐献发展趋势

器官移植术是20世纪出现的针对器官功能衰竭的最有效治疗方法，每年拯救全球超过12万例患者。但供器官短缺的现状，与器官移植技术和辅助药物的发展不匹配，制约了器官移植事业的发展。我国自2015年起已成为全球器官捐献和移植大国之一，2017年公民逝世后器官捐献数量超过5 000例，占全球捐献总量的15%以上。黄洁夫教授总结的器官捐献与移植"中国模式"得到了世界卫生组织、国际移植界的高度重视和充分肯定。本文通过整理全球及各国的器官捐献与移植数据，剖析全球现状与发展趋势，进一步探索我国公民器官捐献的影响因素并提出针对性的应对策略，以期实现我国器官捐献和移植的"自给自足"。     

Increasing organ donation rates from Muslim donors: lessons from a successful model

As the great majority of the population in Saudi Arabia is Muslim, the Islamic views about organ donation and transplantation have been the focus of interest to the transplant community in this and other Muslim countries. The first resolution of the Islamic council in Saudi Arabia (Senior Ulama Commission) about organ donation and transplantation was issued in 1982. It permitted tissue and organ transplantation from both living and cadaveric donors. This resolution marked a new era in organ transplantation in Saudi Arabia, leading to the formation of the Saudi Center of organ transplantation (SCOT), which organizes the process of organ donation and transplantation in Saudi Arabia. There were major strategies to reach the goals of the organ procurement centers adopted by SCOT: improving the awareness of the medical community to the importance of organ donation and transplantation, improving the awareness of the public at large to the importance of organ donation and transplantation, and developing an efficient coordinated system with both the donating hospitals and the transplant centers. Various organs had been transplanted in Saudi Arabia through the end of 2002: 3759 kidney transplants (1267 cadaver, 2492 living); 279 liver transplants(225 cadaver, 54 living); 92 heart transplants; 421 cornea transplants; 8 lungs; and 5 combined kidneys and pancreas. In addition, there have been many tissue donations of bone marrow, heart valves (264 hearts), skin, and bone. Despite the success of the Saudi program, there have been public and medical obstacles that have obviated the full benefit of cadaver donors. We suggest increasing the awareness of the medical community and the public at large to the importance of organ donation and transplantation.     

Thematic Analysis of the Organ Transplantation News in Turkish Press

BackgroundOrgan transplantation, which is one of the most important developments in medical technology and a successful treatment against irreversible life-organ insufficiency, gives people a second chance at life and increases their quality of life. The aim of this qualitative research is to detect how often organ transplantation news is reported in the Turkish press and to analyze the content of this news.MethodsThe data in this qualitative study were obtained from the first 3 most widely read newspapers (Posta, Hürriyet, and Sabah) in Turkey between January and July 2018. Data were analyzed using thematic analysis.ResultsWhen the newspapers were examined, only 17 texts on organ transplants were obtained during a period of 6 months. Six themes were defined after the data analysis. These themes were (1) information on the organ transplantation process, (2) emotional reactions, (3) medical knowledge, (4) importance of organ donation, (5) organ transplant in Turkey, and (6) legal regulation. Most news focused on the emotional reactions of patients and their families and information on the organ transplantation process.ConclusionsWhen we looked at the whole content in Turkish press, there was a place for organ transplantation. However, it is considered that in press news, where people access information easily, more space should be given to organ transplantation to create awareness of how vital it is in changing some people’s lives; health professionals and journalists need to work collaboratively to reach this aim.     

抗体类免疫诱导剂在实体器官移植中的应用现状

器官移植是治疗终末期器官衰竭的首选有效治疗方法,然而器官移植术后早期急性排斥反应往往是导致移植失败的重要因素。为了减少器官移植后排斥反应的发生,往往需要在移植前或移植中加用强效免疫抑制剂对受体免疫系统进行抑制性诱导治疗。抗体类免疫诱导剂作为器官移植早期实施覆盖性免疫抑制治疗的常用方法,可显著减少器官移植术后早期急性排斥...     

Is thyroid cancer prognosis affected by solid organ transplantation?

BackgroundThyroid nodules discovered incidentally during transplant may prolong time to transplantation. Although data suggest that incidence of thyroid cancer increases after solid organ transplantation, the impact on prognosis in differentiated thyroid cancer is not well characterized.MethodsWe performed a retrospective review of patients with history of thyroid cancer and solid organ transplantation at our institution.ResultsA total of 13,037 patients underwent solid organ transplantation of which there were 94 patients with differentiated thyroid cancer (0.7%). Of these, 50 patients (53%) had cancer pre–solid organ transplantation, whereas 44 patients (47%) developed cancer post–solid organ transplantation. Papillary histology was most common (88%), followed by follicular (3%), Hurthle cell (3%), and medullary (2%) carcinomas. One patient in the post-transplant cohort died from metastatic thyroid cancer 11.8 years after transplantation. There were 5 patients in the pre-transplant group and 4 patients in the post-transplant group who had recurrent thyroid disease. There were no patients treated for differentiated thyroid cancer pre–solid organ transplantation that experienced disease recurrence after transplantation. Disease-free survival at 5 and 10 years was 95.8% and 92.1% (confidence interval 84.9–99.2%, 80.0–97.4%) in the pre–solid organ transplantation group vs 89.7% and 84.4% in the post (confidence interval: 80.0–96.3% and 79.0–93.1%, P = .363), respectively.ConclusionSurvival outcomes and recurrence rates in patients with thyroid cancer are not significantly affected by solid organ transplantation. A history of thyroid cancer or discovery of thyroid nodules during transplant screening should not be a contraindication for transplant listing.