心臟移植照護手冊 4061-003C by HoChiBooks

Ԕ ͕᝙ொങĂߏϫ݈͕᝙਽აϐഇঽ ˠĂੵ˞͕᝙ᅃӄጡγĂ౵‫˘۞ޢ‬ቢԓ ୕Ą‫ ܕ‬30 ѐֽĂέ̂ᗁੰ͕᝙ொങဥฤ ۧ޺඾ჟৈՐჟĂҋԧ෹෸۞ჟৠĂ̙ ᕝгವՐჟซᄃࡎ৔Ă͕᝙ொങ۞ј‫ڍ‬ ̏྿͵ࠧ৺ͪ໤Ă౹ϲкีέ៉ăֲ߷ ̈́Б஧۞͕᝙ொങࡔᐂĄொങ࠹ᙯԫఙ ᄃ‫ڼ‬ᒚ͞ࢬ൴ण΍кี౹າᄃԼ։Ă֭ ᒔ଀ᅳА͵ࠧͪ໤۞јᒻĂ൴ܑ˯Ѻቔ SCI ጯఙኢ͛Ăᒔᔛд઼ᅫᗁጯົᛉ̶ ֳјΑགྷរĂТॡซҖ࠹ᙯ̝ૄᖂࡁ տĂ૲જ࠹ᙯᗁᒚࡊԫ̝൴णĂૈ੊઼ ̰γ͕᝙ொങᗁरĂ֭‫ם‬ӄ઼̰γ̂ጯ ᗁੰ൴ण͕᝙ொങĂ၆ᆧซБϔઉ૵ă ೩̿ᗁᒚͪπѣ‫מ‬෸੒ᚥĄ Ķ̥͕̥ఙķߏᗁरᚙದᑻ͵۞ௐ˘ ྽ळΠᅛĂԧࣇͽѩαфቒ֏ࠎ‫ܐ‬ਾĂ ؆ͽᚶ͟ࡍୣд͘ఙέ̝݈ঽၼ̝य़Ă ࠎঽଈԱವϠ‫ߵ۞׻‬໚Ą ξࢬ˯ኘኢ͕᝙ொങ۞३ᚱᅲ͌Ă ͛̚ኢࢗ۰Հ̙‫଀ٽ‬Ă఺ౄјధк၆ொ ങ࠹ᙯ໰᜕۞̙ϒቁ៍‫ه‬Ăдࢬ၆ঽˠ

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ॡĂᗁ᜕ˠࣶ˵‫࠹ͻ৿ــ‬ᙯྤफ़ĂΞֻ‫׎‬ણ ҂ᄃ၁ᅫᑕϡĂЯѩĂԧࣇᔛኛ၁ᅫણᄃ͕᝙ ொങ۞૞छĂ૟кѐᚗෳ۞ᓜԖགྷរᄃኜАซ ВТ̶ֳĂ೩ֻϒቁ۞ۢᙊĂࠎ᝝۰޽͔ਜ਼ ߺĂឰঽଈᒔ଀౵ԁච۞෧ᒚ໰ᜪĄણᄃώ३ በᆷ۞ү۰Ăπॡፆ‫׎‬ཐ͘Ăା‫ڼ‬ঽଈĂ؆ͽ ᚶ͟Ăยີ൑ೀĄѩѨਕ̶̙‫ك‬ѩăཏඉཏ ˧Ă୮̙ᖟռ۞೩΍ᚗෳགྷរĂߏᙱ଀۞஽ ົĄ༊൒Ă‫إ‬ѣధкጯᙊᖳಱ۞૞छĂ‫ٺݫ‬ॡ ۩ٙࢨĂ̙̈́೭‫׎‬т♇̂ඊĂஎຏ᏷঴̝ጹĄ ள͟ѣॡĂ࠽ਕВᓷ஽ᓝĂᆅ୹Ճ‫ྖָڒ‬Ą ώ३่ಶ͕᝙ொങ̝ૄώໄ‫ܕ̈́ه‬ѐдέ ̂ᗁੰᓜԖ໰᜕ঽˠགྷរઇ˘୺ព҃ྭࡊҾፋ Ъّ۞̬௜Ăԓ୕ֹ᝝۰ਕ˘᎚ѩপঅᅳા̝ ̂ࢋĄЯѩĂώ३ዋЪүࠎᗁጯˠࣶ‫ܐ‬Ѩତᛈ ѩᅳા۞ˢ‫ܝ‬३ᚱĂ˵ዋЪᐌ֗ᛸ૲Ăֻણ҂ ߤዦ̝ϡĄ౵‫ޢ‬Ăώ३ጐგགྷ።७ዦ࣒ϒĂ̰ ट̪̙Һѣᖱᄱᄃழ႒̝఍Ă‫إ‬ኛЧ͞Аซ̙ ӊ޽ϒĂຏ‫ه‬ҌໂĊ

ͳͪஎ

ᖰᙊ

2014.5.20

ү۰ᖎ̬ Ğֶඊ൪ଵЕğ

ͳͪஎ (Shoei-Shen Wang, M.D., Ph.D.) னᖚĘέ̂ᗁੰ͕᝙ொങΡะˠ έ̂ᗁੰ͕۱ொങ͹޺ˠ έ̂ᗁੰ͕᝙ҕგγࡊ͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāି଱ ઼ϲᄂ៉̂ጯ࿪፟ྤੈጯੰϠᗁ࿪̄ᄃ ྤੈጯࡁտٙāି଱ έ៉ொങᗁጯጯົநְ‫ܜ‬ ૞‫ܜ‬Ę͕᝙ҕგγࡊă݄‫ې‬જਔᖒ྽͘ఙăᘝ ቯ͘ఙă͹જਔሳăᐖਔѡૺă‫׹‬ᙝҕ გă͕᝙ொങă͕᝙ᅃӄጡă͕᝙਽ა ۞‫ڼ‬ᒚ

ͳങኰ (Chih-Hsien Wang, MD., PhD.) னᖚĘέ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāᓜԖᓾर ૞‫ܜ‬Ęࢦাᗁᒚ̈́፟ୠೈᒖᅃӄĞཧҹቯཉ ˢă͕‫ވ‬ᅃӄጡğ ă݄‫ې‬જਔᖒ྽͘ ఙă͕᝙̙ઃྯ͘ఙă͕᝙ᘝቯཉೱ͘ ఙă͕᝙਽ა‫ڼ‬ᒚ

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ͨ̈ᓧ (Siu-Mei Mo Lee) னᖚĘέ̂ᗁੰᑭរᗁጯొઘ͹Ї ૞‫ܜ‬ĘᓜԖᑭរᗁጯăᑭរ૞ຽᏙྙ

ѯᴣጙ (Chiang Chang-Hsun) னᖚĘ‫ۏ‬ந‫ڼ‬ᒚर

ң୿ಬ (Shu-Yuan Ho) னᖚĘঽ߲ᑭរ௡௡‫ܜ‬

ӕׂৌ (Lu Pei-Chen) னᖚĘ‫ۏ‬ந‫ڼ‬ᒚर

Ղୁ‫( ځ‬Chii-Ming Lee, M.D., Ph.D.) னᖚĘέ̂ᗁੰ̰ࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāઘି଱ ૞‫ܜ‬Ę̰ࡊጯă͕᝙ጯă຅௟ࡪ̶̈́̄Ϡ‫ۏ‬ጯ

Ղ‫ځ‬ᑺ (Ming-Been Lee, M.D.) னᖚĘέ̂ᗁੰჟৠᗁጯొ͹‫ڼ‬ᗁर ᄂ̂ᗁጯੰჟৠࡊ̈́ۤົᗁጯࡊି଱ ૞‫ܜ‬Ęჟৠᗁጯă͕֗ᗁጯăᗁጯ͕நጯă ᗁጯିֈăᗁጯࣖந

ү۰ᖎ̬ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

‫׹‬੝ᆵ (Nai-Kuan Chou, MD.,LLM.,PhD.) னᖚĘέ̂ᗁੰγࡊొΐ᜕ঽٗ͹Ї έ̂ᗁੰγࡊొጡ‫ء‬ᚍ๒̈௡Ρะˠ έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲέ៉̂ጯᗁጯրāᓜԖઘି଱ ૞‫ܜ‬Ęវγೈᒖă͕᝙γࡊăࢦাᗁጯă͕‫ވ‬ᅃӄ ጡă͕᝙ொങăጡ‫ء‬ᚍ๒ăᗁְ‫ޠڱ‬

ࡔ˜າ (Nai-Hsin Chi, MD., PhD.) னᖚĘέ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāᓜԖઘି଱ ૞‫ܜ‬Ę͕᝙ொങă˟ыᘝ࣒ྃ͘ఙă͕᝙ᘝቯཉೱ͘ ఙă຋౹ᘝቯཉೱ͘ఙă͹જਔࣤᗓ͘ఙă ͹જਔሳ͘ఙă͕᝙਽ა‫ڼ‬ᒚă͕‫ވ‬ᅃӄጡ͘ ఙăཧҹቯཉˢă݄‫ې‬જਔᖒ྽͘ఙă͕᝙̙ ઃྯ݄‫ې‬જਔᖒ྽͘ఙ

ग‫( ༽ض‬Hsin-Yun Sun) னᖚĘέ̂ᗁੰ̰ࡊొຏߖࡊ͹‫ڼ‬ᗁर ᄂ៉̂ጯᗁጯੰāᓜԖӄநି଱ ૞‫ܜ‬Ę̰ࡊጯăຏߖাăຑൄঽጯăឣෂຏߖă ጡ‫ء‬ொങຏߖ

गछഏ (Shun,Chia-Tung,M.D.,Ph.D.) னᖚĘέ̂ᗁੰঽநొ͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯ‫ڱ‬ᗁጯࡊāି଱ ૞‫ܜ‬Ę‫ڱ‬ᗁঽநጯă͕᝙ொങঽநጯ

vii

viii

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

୓็ِ (Chuan-I Tsao, RN) னᖚĘέ̂ᗁੰጡ‫ء‬ொങ᜕நर (transplant coordinator) ૞‫ܜ‬Ę͕᝙ொങăጡ‫ء‬ॕᙑ

ౘ‫ޥ‬ᅈ (Ssu-Yuan Chen, MD, PhD) னᖚĘέ̂ᗁੰೇઉొ͹‫ڼ‬ᗁर ᄂ៉̂ጯᗁጯੰᗁጯրೇઉࡊӄநି଱ ૞‫ܜ‬Ęҁˠᗁጯă͕᝙ೇઉăྻજϠநጯ

ౘৈே (Yih-Sharng Chen, MD, PhD.) னᖚĘέ̂ᗁੰ͕᝙ҕგγࡊ͹Ї έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāି଱ ૞‫ܜ‬Ę̈‫׊‬ฟ͕͘ఙăјˠฟ͕݄‫ې‬જਔᖒ྽͘ఙă ͕᝙ᘝቯ࣒ྃఙă͕᝙ᘝቯཉೱఙኑᗔ̝А͇ ّ͕᝙ঽĈ̂જજਔᖼҜĂν͕‫ވ‬൴ֈ̙Бă ಏ͕‫ވ‬ೈᒖ̝ˬล߱͘ఙă͕̰ቯါள૱ă͹ જਔ͘ఙăฉᙝҕგ͘ఙă͕᝙ொങă͕਽ა ͘ఙă͕‫ވ‬ᅃӄጡങˢ

เ३ઉ (Huang,Shu-chien MD, PhD.) னᖚĘέ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāᓜԖઘି଱ ૞‫ܜ‬ĘАّ͇͕᝙ঽ͘ఙăᑈ‫׊‬ഇ͕᝙γࡊă̈‫͕׊‬ ᝙γࡊăјѐˠАّ͇͕᝙ঽăಏ˘͕‫ވ‬А͇ ّ͕᝙ঽăࢦাᗁᒚ̈́፟ୠೈᒖᅃӄĞཧҹ ቯă͕‫ވ‬ᅃӄጡğ

ү۰ᖎ̬ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

࿥̯า (Yun-Wen Yung, RN) னᖚĘέ̂ᗁੰ͕ҕგ͕̚ΐ᜕ঽ᜕ٗந‫ܜ‬ ૞‫ܜ‬Ę͕᝙ҕგγࡊ

ၐ̀඀ (Shih-Cheng Liao, M.D., Ph.D.) னᖚĘέ̂ᗁੰჟৠᗁጯొ͹‫ڼ‬ᗁर ᄂ៉̂ጯᗁጯੰჟৠࡊᓜԖӄநି଱ ૞‫ܜ‬Ęჟৠᘽ‫ڼۏ‬ᒚă͕֗ᗁጯăҁѐჟৠᗁጯ

ᆒЏઈ (Chao-Wei Liu) னᖚĘϠ̼ᑭរ௡௡‫ܜ‬

ᆒ೺ำ (Fei-Yun Liu) னᖚĘᏮҕၱொങᑭរ௡௡‫ܜ‬

Ꮒ୿‫( ۾‬Hsiao Shu-Fang) னᖚĘ‫ۏ‬ந‫ڼ‬ᒚर

ᖎຎᆇ (Tzu-I Chien) னᖚĘღާᑭរ௡௡‫ܜ‬

ϫ ᐂ ԔĘ૟͕͕ͧĂ˘ਔ࠹็................................ iii ү۰ᖎ̬ ......................................................... v ௐ 1 ౢĘ͕᝙ொങ۞൴ण ͳͪஎ ............................................. 1 ௐ 2 ౢĘ͕᝙ொങ۞߹඀ᄃ࠹ᙯఢቑ ୓็ِ ............................................11 ௐ 3 ౢĘ͕᝙ॕᙑ۰۞ෞҤᄃࣖநᛉᗟ ‫׹‬੝ᆵ ........................................... 27 ௐ 4 ౢĘ͕᝙ொങ݈‫۞ޢ‬፟ୠᅃӄ ౘৈே ........................................... 47 ௐ 5 ౢĘ͕᝙ொങ͘ఙᄃ໤౯ ࡔ˜າ ........................................... 57 ௐ 6 ౢĘ͕᝙ொങ‫ޢ‬дΐ᜕ঽٗ۞໰᜕ ͳങኰ ........................................... 65 ௐ 7 ౢĘ͕᝙ொങ‫۞ޢ‬ᗁᒚ໰᜕ ͳͪஎ ........................................... 75 ௐ 8 ౢĘ͕᝙ொങ۞͕᝙Αਕᑭߤ Ղୁ‫ ځ‬......................................... 105 ௐ 9 ౢĘ͕᝙ொങ‫۞ޢ‬ঽநត̼ गछഏ ......................................... 117 ௐ 10 ౢĘ͕᝙ொങ‫۞ޢ‬ຏߖ఍ཉ ग‫ ༽ض‬......................................... 125

xii

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ௐ 11 ౢĘ̈‫͕׊‬᝙ொങ เ३ઉ ......................................... 137 ௐ 12 ౢĘ͕᝙ொങ‫۞ޢ‬ΐ᜕ঽ᜕ٗந ࿥̯า ......................................... 151 ௐ 13 ౢĘ͕᝙ொങ‫۞ޢ‬ঽٗ໰᜕̈́‫ا‬छ᜕ந ୓็ِ ......................................... 163 ௐ 14 ౢĘ͕᝙ொങ݈‫ྻ۞ޢ‬જ੊ቚ ౘ‫ޥ‬ᅈăᏂ୿‫۾‬ăӕׂৌăѯᴣጙ .................................................... 187 ௐ 15 ౢĘ͕᝙ொങ۞ჟৠࡊ໰ົᓑથĈ Бˠ໰᜕۞ར၁ Ղ‫ځ‬ᑺăၐ̀඀........................... 205 ௐ 16 ౢĘ͕᝙ொങᑭរีϫ̈́‫׎‬ᓜԖຍཌྷ ͨ̈ᓧăң୿ಬăᆒЏઈăᆒ೺ำă ᖎຎᆇ ......................................... 215 ‫ܢ‬ᐂ ............................................................ 247 ˘ăˠវጡ‫ء‬ொങ୧ּƟ 248 ˟ăˠវጡ‫ء‬ொങ୧ּ߉Җ௟‫݋‬Ɵ 258 ˬăཝѪҿ‫ؠ‬୧ּƟ 263 ‫ ܑܢ‬1 Ɵ 269 ‫ ܑܢ‬2 Ɵ 270 ‫ ܑܢ‬3 Ɵ 271 αă‫ގ‬វጡ‫ء‬ॕᙑ۰൳ᐂܑॾƟ 272 ̣ă͕᝙ொങඈ࣏۰൳ᐂܑॾƟ 275 ̱ă͕᝙ொങ࣎९੠ᖸܑॾƟ 280 ˛ăᄂ̂ᗁੰ኎ିಏૺƟ 281 (˘) ͕᝙ொങ͘ఙᄲ‫ځ‬३Ɵ 281 (˟) ͕᝙ொങఙ‫۞ޢ‬૱֍ᑭߤƟ 286 (ˬ) ͕᝙ொങఙ‫ޢ‬΍ੰ኎ି޽ጱƟ 290

৶͔ ............................................................ 297

͕᝙ொങ۞൴ण

ͳͪஎ (Shoei-Shen Wang, M.D., Ph.D.) έ̂ᗁੰ͕᝙ொങΡะˠ έ̂ᗁੰ͕۱ொങ͹޺ˠ έ̂ᗁੰ͕᝙ҕგγࡊ͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāି଱ ઼ϲᄂ៉̂ጯ࿪፟ྤੈጯੰϠᗁ࿪̄ᄃྤੈጯ ࡁտٙāି଱ έ៉ொങᗁጯጯົநְ‫ܜ‬

ᙯᔣෟ (Keywords) ˠវጡ‫ء‬ொങ୧ּ Human Organ Transplantation Act, HOTA

ν͕‫ވ‬ᅃӄጡ Left Ventricular Assist Device, LVAD έ៉ொങᗁጯጯົ The Transplantation Society of Taiwan έ៉ጡ‫ء‬ॕᙑொങ൳ᐂր௚ Taiwan Organ Registry and Sharing System

۲‫҉ّ͕ݓ‬া Hypertrophic cardiomyopathy ݄‫ې‬જਔ়ঽ Coronary artery disease ளҜ͕᝙ொങ Heterotopic heart transplantation ୣٛপᗕ͕‫ވ‬ᅃӄጡ Thoratec biventricular assist device ය͕ۤ Jing-Shin Association ൛൛ Chimpanzee

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

(˘) රˠ౵ѝ۞͕᝙ொങ [1] ॡ

มĈҘ̮݈ 300 ѐ

ᗁ

रĈ޴ᚆ

ঽ

ˠĈጆ̳ଞĂᅀᆅᑈ

ॕᙑ۰ĈᅀᆅᑈĂጆ̳ଞĞ͕᝙̢ೱğ

(˟) Ҙ͞౵ѝ۞͕᝙ொങ [2] ॡ

มĈ 1964 ѐ 1 ͡ 23 ͟

ᗁ

रĈ૜ Ҙ Ҙ ͧ ̂ ጯ ᗁ ጯ ̚ ͕ ů ‫ ݣ‬г (James D. Hardy)

ঽ

ˠĈ68 ໐Ϩˠ Boyd RushĂշّĂ݄‫ې‬ જਔ়ঽ (coronary artery disease)Ą

ॕᙑ۰Ĉ൛൛ (chimpanzee)

(ˬ) Ҙ͞ࢵּјΑ۞͕᝙ொങ [3] ॡ

มĈ 1967 ѐ 12 ͡ 3 ͟

ᗁ

रĈ‫ ܧ ݑ‬ฟ ೼ ೶ ̂ ጯ Groote Schuur Hospital ů͐ৼᇇ (Christiaan N. Barnard)Ą

ঽ

ˠĈ53 ໐ϨˠĞϲ౜‫ؤ‬ˠĂ 9 ໐ಶொ ϔ‫ܧݑז‬ğLouis Washkansky Ăշ ّĂ݄‫ې‬જਔ়ঽĄ

ॕᙑ۰Ĉ25 ໐Ϩˠ Denise Darvall ẴّĂ ֘჋Ą

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1.ĮЕ̄įĈ഼યቔ 2. Hardy JD, Chaves CM, Kurrus FE, et al: Heart transplantation in man: development studies and report of a case. JAMA 1964;188:1132-5. 3. Barnard CN: A human cardiac transplant: An interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. S Afr Med J 1967;41:1271-4. 4. Wang SS, Chu SH: Current status of heart assist and replacement in Taiwan. Artif Organs 1996;20:1325-9. 5. Tilney NL. Transplant: From Myth to Reality. New Haven: Yale University Press, 2003. 6. Wang SS, Wang CH, Chou NK, et al. Current status of heart transplantation in Taiwan. Transplant Proc 2014;46:911-3.

͕᝙ொങ۞߹඀ ᄃ࠹ᙯఢቑ

୓็ِ (Chuan-I Tsao,RN) έ̂ᗁੰጡ‫ء‬ொങ᜕நर (transplant coordinator)

ᙯᔣෟ (Keywords) ொങఙ݈ෞҤ Pre-transplantation evaluation ዋᑕা Indication ༰ԟা Contraindication ̶੨ࣧ‫ ݋‬Allocation

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ொങఙ݈ෞҤ 1. ᓜԖᗁर‫ܐ‬Վ෧ᕝঽˠࠎϐഇ͕᝙਽აᅮү ͕᝙ொങॡĂΞᖼ̬Ҍ͕᝙γࡊซҖෞҤ̍ үĂ͹ࢋߏซ˘ՎෞҤঽˠ۞͕᝙‫׎̈́ڶې‬ ΁֗វΑਕඈĄ 2. дٙѣᑭߤ‫ޢ‬ĂொങဥฤົฟົซҖ੅ኢĂ གྷ͕᝙ொങઉܲᆶߤ఼࿅‫ޢ‬ϒё൳ᐂඈ‫ޞ‬Щ ಏ̚ćϏ௑Ъொങᇾ໤ٕѣ༰ԟা۰‫݋‬ᚶᜈ ჯ޺ࣧࡊᗁᒚĄ 3. ѣॡঽଈЯ‫͕׎‬᝙Αਕ਽ა۞ᙯܼĂΞਕд ඈ‫ޞ‬ഇมᅮࢋЧ჌‫ܬ‬ˢّ۞ཉ‫ٸ‬྅ཉٕᅃӄ ྅ཉĈт͕‫ޠ‬አ༼ጡă‫ײ‬ӛጡă͹જਔঈ஧ ᑒ঒ăវγೈᒖᅃӄጡăν͕‫ވ‬ᅃӄጡ۞ᑒ ӄĄ

˟ă ொങఙ݈ෞҤ (pre-transplantation evaluation)

(˘) ϫ۞ Яࠎఙ‫ޢ‬ҺࠪԺ‫ט‬጗۞ֹϡĂБ֗Чր௚ ӮѣΞਕ‫צ‬ᇆᜩĂඈ‫ޞ‬ொങ‫צ‬ᙑ۰ࢋԆјྎ௟ ۞ঽΫ‫֗׶‬វᑭߤĂ̙ਕΪઇᄃ͕᝙਽აѣᙯ ۞ᑭߤĄ

͕᝙ொങ໰᜕͘Ί

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

൴াĄ ጡ‫ء‬ொങᗁᒚဥฤЯຽચ҃ۢଉ‫ޞ‬ொങ۰ ̈́‫צ‬ொങ۰̝‫ؖ‬Щ̈́࠹ᙯྤफ़Ă̙଀൑߇ࠈ ႒Ą

‫צ‬ᙑ۰ྤफ़఼ಡ 1. ‫צ‬ᙑ۰ତ‫צ‬ጡ‫ء‬ொങ͘ఙ‫ޢ‬Ăᗁੰ૟‫׎‬ҋඈ ࣏۰Щಏ̰ொ΍Ą 2. ᗁੰᑕ‫ٺ‬Տѐ 1 ̈́͡ 7 ͡‫݈غ‬Ă˯შ๱ᆷĶጡ ‫ء‬ொങ࣎९੠ᖸܑॾķ Ă૟݈̱࣎͡߉Җ͘ఙ ̈́੠ᖸଐԛĂֶ໰Ķொങ͘ఙఙ‫ޢ‬੠ᖸ˯შ ఼ಡፆүืۢķ఼ಡ൳ᐂ͕̚Ą

ણ҂३ϫ 1. ੑ ဥ ‫ ڱ‬ˠ ጡ ‫ ء‬ொ ങ ൳ ᐂ ̚ ͕ Ĉ ጡ ‫ ء‬ॕ ᙑ ொ ങ ͘ ΊĄϔ 103 ѐ 5 ͡ 5 ͟Ă‫פ‬ҋĈ http://www.torsc.org. tw/transplant/transplant_09.jsp# Plans Ą 2. ᄂ̂ᗁੰጡ‫ء‬ဥฤĄϔ 103 ѐ 5 ͡ 5 ͟Ă‫פ‬ҋĈ http://www.ntuhtx.org.tw/ch/organ/organ_List.asp?Vol umn_ID=438 Ą

͕᝙ॕᙑ۰۞ ෞҤᄃࣖநᛉᗟ

‫׹‬੝ᆵ (Nai-Kuan Chou, MD.,LLM.,PhD.) έ̂ᗁੰγࡊొΐ᜕ঽٗ͹Ї έ̂ᗁੰγࡊొጡ‫ء‬ᚍ๒̈௡Ρะˠ έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲέ៉̂ጯᗁጯրāᓜԖઘି଱

ᙯᔣෟ (Keywords) ˠᙷҺࠪ৿ౝঽ߲ Human Immunodeficiency Virus, HIV ˠវጡ‫ء‬ொങ୧ּ Humman Ogran Transplantation Act, HOTA

๋̙चࣧ‫ ݋‬The Principle of Nonmaleficence ͕̚ᐖਔᑅ Central Venous Pressure, CVP ̳πϒཌྷࣧ‫ ݋‬The Principle of Justice ͕‫ވ‬ᒺൺ Shortening Fraction, SF ͕᝙෹ࢰ‫ گ‬Echocardiography ν͕ٗᑅ Left Atrial Pressure, LAP ν͕‫ވ‬ϐഇනૺ෼ᗓ Left Ventricular End Diastolic Distance, LVEDD

Фঈϐഇϒᑅ Positive End Expiration Pressure, PEEP Җචࣧ‫ ݋‬The Principle of Beneficence ԩ C ‫ݭ‬ք‫ۆ‬ԩវ Anti-HCV antibody ݄‫ې‬જਔ়ঽ Coronary Artery Disease, CAD ಴ࢦҋ͹ࣧ‫ ݋‬The Principle of Respect for Autonomy

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ͕᝙ொങॕᙑ۰ෞҤ ͕᝙ொങॕᙑ۰ෞҤ‫׎‬Αਕ‫ې‬ၗߏ͕᝙д ߿វॡ۞‫ڶې‬Ăಶߏ‫פ‬ՙߏ̙ߏዋЪॕᙑ͕ ᝙Ăॕᙑ۰ѣ˭Еଐ‫ڶ‬ಶ̙ዋЪॕ͕᝙Ĉ

(˘) ඗၆̙ዋЪॕᙑ͕᝙ [1][2] 1. ѣˠᙷҺࠪ৿ౝঽ߲ (Human Immunodeficiency Virus, HIV) ຏߖĄ 2. ೋّཚሳĄ 3. ѐ᛬̂‫̣˩̱ٺ‬໐˫͕᝙݄‫ې‬જਔ়ঽ (Coronary Artery Disease, CAD)Ą 4. B ‫ ׀ݭ‬C ‫ݭ‬ք‫ۆ‬ຏߖ͕᝙ॕᙑ۰Ą૱֍ົౄј ொങ͕᝙۞݄‫ې‬જਔҕგঽតĄ

(˟) ࠹၆̙ዋЪॕᙑ͕᝙ 1. B ‫ ٕݭ‬C ‫ݭ‬ք‫ۆ‬ຏߖĄϤ‫ٺ‬έ៉ॕᙑ͕᝙ᇴณ ҲĂለ࡚۞ጡ‫ء‬ॕᙑࢲঈ̪ྵέ៉ࠎ౼Ăለ ࡚ጡ‫ء‬ॕᙑπӮՏ͇ՏѺ༱ˠ˾̚ಶѣ˟˩ Ҍˬ˩̣ˠĂέ៉ጡ‫ء‬ॕᙑՏѺ༱ˠ˾Ϊ྿ ˩ˠ˯˭Ą͕᝙ֽ໚̙֖̝˭Ă B ‫ ٕݭ‬C ‫ݭ‬ ք‫ۆ‬ຏߖॕᙑ۰͕᝙ĂপҾϡ࿪ཝ੨၆ගღ ާା‫͕׻‬᝙ඈ‫ޞ‬۰Ą

ௐ 3 ౢā͕᝙ॕᙑ۰۞ෞҤᄃࣖநᛉᗟ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

‫ء‬۰‫׎‬Ꮠᛳܑ̝ೳ̈́ಉཨ෱̝ྃӄ۞ఢ‫ؠ‬Ă‫݋‬ ѣӀ‫̳ٺ‬ிҋᙸॕᙑጡ‫ء‬Ăֹጡ‫ء‬ொങᒔ଀Հ кֽ໚Ą˯ࢗఢ‫̙ؠ‬ҭѣӀ‫ٺ‬ᗁर߉Җጡ‫ء‬ொ ങ͘ఙĂ˵ѣӀ‫ٺ‬၆ጡ‫ء‬਽აঽˠϠ‫߀۞׻‬ ାĄೱ֏̝ĂĶˠវጡ‫ء‬ொങ୧ּķ۞߉ҖĂ ˵ಶߏ၆ொങᗁጯ۞ᑕϡᄃ൴ण۞‫׍‬វ၁ன [10]

ણ҂३ϫ 1. Onnen Grauhan : Screening and assessment of the donor heart Applied Cardiopulmonary Pathophysiology 2011;15: 191-197. 2. Weymann A, Schmack B, Szabo G : Pathophysiological consequences of brain death. Transplantations medizin 2011;23: 140-145. 3. Wagner F: Donor Heart Preservation and Perfusion. Transplantations medizin 2011;23: 152-158. 4. Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010 Aug;29(8):914-56. 5. Ana MS, L. Maximilian B, Cardiac Allograft Vasculopathy. Tex Heart Inst J. 2013; 40(4): 400-402.

͕᝙ொങ݈‫۞ޢ‬ ፟ୠᅃӄ

ౘৈே (Yih-Sharng Chen, MD, PhD.) έ̂ᗁੰ͕᝙ҕგγࡊ͹Ї έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāି଱

ᙯᔣෟ (Keywords) ፟ୠೈᒖᅃӄ Mechanical circulatory support ፟ୠೈᒖᅃӄᓑ൳ᐂ INTERMACS

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ͕᝙਽ა̶̝ഇ д੅ኢ͕᝙ொങ (heart transplantation, HTx) ̝፟ୠᅃӄೈᒖ (mechanical circulatory support, MCS) ݈ĂࢋА੅ኢ͕᝙਽ა̶̝ഇĂ˞ྋ˞‫׎‬ ̶৺̖ਕՙ‫ؠ‬ңॡᅮࢋ፟ୠᅃӄೈᒖĄ ͽ‫ͽߏـ‬৸ࡗ͕᝙Αਕඈ৺ֽઇ̶৺Ăҭѩ ̶৺‫׎‬͹៍ّ‫ࢦޝ‬Ă̙ૉ‫៍މ‬ĂΪͽা‫ֽې‬ડ ̶Ăͷ‫צ‬ঽଈ̈́‫׎‬छᛳ̝ҋԧᄮۢ̈́͹៍˯̝ೡ ࢗѣٙमҾĂ͍‫ߏ׎‬ௐ˟৺̈́ௐˬ৺̝ҿ‫ؠ‬Ą 1. ࡚ ઼ ৸ ࡗ ͕ ᝙ ‫ ͕ ົ ם‬਽ ა ̝ ̶ ৺ (NYHA system) ‫߿ֶߏܮ‬જࢨ‫۞ט‬඀‫ޘ‬үࠎ়ঽᚑࢦ ‫̶̝ޘ‬৺Ą 2. ѩ̶৺ֶፂ͟૱֗វ߿જॡ͔੓۞িࢽă‫ײ‬ ӛӧᙱă͕ଙٕ͕ඔ൭ඈা‫̶ې‬јα৺Ğܑ 4-1ğ Ą ன̫ॲፂ 2011 ઼࡚͕᝙ጯົ̝໤‫ޙ݋‬ᛉĂ ϡೀ࣎޽ᇾֽෞҿ͕᝙਽ა۞ᚑࢦ඀‫ޘ‬ĂΒ߁ ˞ν͕‫ވ‬ќ㈉ͧத (LVEF, left ventricular ejection fraction)Ă̝݈̝ঽΫĂ̝݈̝ϡᘽĂछ୉়ঽ ΫĂߏӎѣᎤԌঽă੼ҕᑅă۲ࡡĂΐ˯͕᝙ ਽ა̝া‫ې‬Ăߏӎѣඕၹّ̝͕᝙ᘝቯٕ݄‫ې‬ જਔ̝ঽតֽઇࠎ̶ഇĄ

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 2013:32:157-187. 2. 2013 ACCF/AHA guideline for management of heart failure. J Am Coll Cardiol 2013:e147-239. 3. Recommendation for the use of mechanical circulatory support: device strategies and patients selection. Circulation 2012:126:2648-2667.

͕᝙ொങ͘ఙ ᄃ໤౯

ࡔ˜າ (Nai-Hsin Chi, MD.,PhD.) έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāᓜԖઘି଱

ᙯᔣෟ (Keywords) ͕᝙෹ࢰ‫ گ‬Echocardiography ϒҜ͕᝙ொങ Orthotopic heart transplantation ௟ࡪҺّࠪଵϋ Cellular rejection ԩវҺّࠪଵϋ Antibody-mediated rejection ෹ާّଵϋ Hyperacute rejection ளҜ͕᝙ொങ Heterotopic heart transplantation

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ॕᙑ۰͕᝙ၡ‫פ‬ (˘) ͕᝙ᑭෛ 1. ϒ̚਒੻̷ฟĄ 2. ̷ฟ͕ΒቯĂ͕Βቯ̷ฟҌ˭ටᐖਔᄃፖჽ ቯ఍ĄΞͽ૟Π۱҈ቯχฟĂͽӀᆿҕଵҌ Π઎਒ටĄ 3. ෞҤ͕᝙ߏӎѣયᗟĈ ఙ݈ᔵ൒̏གྷѣ͕᝙Αਕྤफ़ෞҤĂχฟ਒ ට˵ࢋෞҤ͕᝙ĄෞҤ͹જਔߏӎѣள૱ถ ̼Ăᇬၤ۱જਔĂνΠ͕ٗĂᑭߤߏӎѣள ૱Ąቁ‫͕ؠ‬᝙݄‫ې‬જਔ՟ѣள૱ถ̼Ą 4. ఼ۢொങ‫צ‬ᙑ఍໤౯ᗁरĂ࿰Ҥ͕᝙‫˭פ‬ॡ มĂ‫צ‬ᙑ͞ᗁरΞͽѣ·̶ॡม໤౯Ą

(˟) ͕҉᜕ܲĂ̈́͘ఙ͞ё 1. ૟͹જਔ̶ᗓ΍Ă͹જਔ‫ޘܜ‬෸‫ܜ‬Ă͘ఙ෸ щБĄ 2. ̶ᗓ˯ටᐖਔĄ 3. ‫ڦ‬डք৵Ą໤౯͕҉᜕ܲ୵Ă֭ͷઃͤٙѣ ૻ͕጗ٕொੵ͕̚ᐖਔጱგĄϫ݈ϡ᜕ֽܲ ͕҉۞͕᝙౫༑୵ѣ‫ᙷ̂׌‬Ĉඕ೿វ (Crystalloid) ̈́ҕ୵͕᝙౫༑୵Ą

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Vassileva A, Valsecchi O, Sebastiani R, Fontana A, Gamba A. Heterotopic heart transplantation for elevated pulmonary vascular resistance in the current era: long-term clinical and hemodynamic outcomes. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 2013;32:934-6. 2. Listijono DR, Watson A, Pye R, et al. Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction. The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 2011;30:783-9. 3. Chou NK, Chi NH, Yu HY, et al. Extracorporeal rescue for early and late graft failure after cardiac transplantation: short result and long-term followup. TheScientificWorldJournal 2013;2013:364236.

͕᝙ொങ‫ޢ‬д ΐ᜕ঽٗ۞໰᜕

ͳങኰ (Chih-Hsien Wang, MD., PhD.) έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրāᓜԖᓾर

ᙯᔣෟ (Keywords) ˘উ̼ധ Nitric Oxide (NO) ͕ٗᚭΑਕ̙։ Sinoatrial node dysfunction ͕‫̙ޠ‬ፋ Arrhythmia Π͕਽ა Right heart failure ν͕਽ა Left heart failure ‫׊‬ਮ⊱῔ Catecholamine ඪ˯ཛྷ‫צ‬វ Adrenergic receptors ᒤᅕ˟⟯㤲Ժ‫ט‬጗ Phosphodiesterase inhibitor ݈Еཛྷ৵ E1 Prostaglandin E1

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

͕᝙ொങఙ‫ޢ‬ঽଈĂдఙ‫ޢ‬ΐ᜕ঽٗ۞ާ ّഇม۞໰ᜪĂᅮ‫ڦ‬ຍ۞ְีᄃ̂кᇴ۞ฟ͕ ͘ఙଈ۰ᙷҬĂΒӣ˞ఙ‫͕ޢ‬਽აă΍ҕă͕ ‫̙ޠ‬ፋă‫ײ‬ӛ໰᜕ăքඪΑਕඈĄ઱፾Яࣣങ ˢ۞͕᝙ĂΞਕд̝݈̏གྷዎ࿃˞˘ాҚ۞Β ߁ࢦ̂౹๋ăཝѪ࿅඀ăொങ৿ҕॡม̈́Г᛿ ߹๋चăາങˢ۞͕᝙ᄃ‫צ‬ᙑ۰Ϡநᒖဩ۞ዋ ᑕඈયᗟĂֹ଀д͕᝙ொങఙ‫۞ޢ‬ΐ᜕ঽٗഇ มĂĶჯ޺າങˢ۞͕᝙ྻү։рķјࠎ˞ΐ ᜕ঽٗ۞ࢵࢋϫᇾĄ

˘ă Ϡ‫׻‬ᇈ෪ᄃҕҖ˧ጯႾീ ͕᝙ொങఙ‫ޢ‬Ăΐ᜕ঽٗ۞ႾീีϫĂᄃ ˘ਠฟ͕͘ఙ࠹ТĄ 1. ͕࿪ဦ 2. ాᜈજਔᑅ 3. જਔҕউ࿸‫ޘ׶‬ 4. ͕̚ᐖਔᑅ 5. ຍᙊ‫ې‬ၗෞҤ 6. Տ̈ॡԌณ 7. ਒გ̈́‫߹͔΁׎‬გ߹ณ 8. ాᜈ۱જਔᑅĞࡶѣ۱જਔึ߹ጱგğ 9. ాᜈ͕̚ᐖਔҕউ࿸‫ޘ׶‬Ğࡶѣ SvO2ğ 10. ۱຋ҕგແᑅĞPCWP Ăࡶѣ۱જਔึ߹ጱ გğ

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

̱ăඕᄬ ጐგॲፂ͛ᚥಡӘĂາങˢ۞͕᝙дఙ‫ޢ‬ѝ ഇΞਕѣ੼྿ 50% ۞፟ົயϠ̙Т඀‫۞ޘ‬Αਕ̙ ։Ă൒҃дԁච۞ΐ᜕ঽٗႾീᄃ໰᜕̝˭Ăϫ ݈͕᝙ொങ۞ௐ˘࣎͡х߿த̏੼྿ 98% ĄЯ ѩĂ૜ะ۞ႾീăͿ௟۞៍၅Ăᄃ᎕ໂ۞‫ڼ‬ᒚĂ ߏ໰ᜪ͕᝙ொങఙ‫ޢ‬ঽଈјΑ۞ᙯᔣĄ

ણ҂३ϫ 1. ͳͪஎĞ͹በğ(2014)Ąጡ‫ء‬ொങĈ൴னયᗟĂವ ՐྋඍĄέ៉າΔξĈЪ੃ဦ३΍‫ۤۍ‬Ą 2. James K. Kirklin, James B. Young, and David C. McGiffin. (2002). Heart Transplantation. Philadelphia, PA19106: Churchill Livingstone. 3. Paul L. Marino. (2007). The ICU Book (3rd Edition). Philadelphia, PA 19106: Lippincott Williams & Wilkins. 4. Robert M. Bojar. (2011). Manual of Perioperative Care in Adult Cardiac Surgery (5th Edition). West Sussex, UK: Wiley-Blackwell. 5. Wang SS, Wang CH, Chou NK, and et al. (2014). Current Status of Heart Transplantation in Taiwan. Transplantation Proceedings (2014), 46(3), 911-913.

͕᝙ொങ‫۞ޢ‬ ᗁᒚ໰᜕

ᙯᔣෟ (Keywords) ˠᙷϨҕ஧ԩࣧ Human Leukocyte Antigen, HLA ̋ಈк Cellcept ˬᅕϟ‫ڵ‬਌ Triglyceride, TG ͕‫ވ‬ᅃӄጡ Ventricular Assist Device, VAD Ι‫گ‬Ҙͩ҇ሳ Kaposi’s sarcoma λ௟ࡪঽ߲ Cytomegalovirus, CMV ͹જਔ̰ঈ஧ᑒ঒ Intra-Aortic Balloon Pumping, IABP ҕልཉೱఙ Plasmapheresis Ҳ૜‫ޘ‬਌కϨ Low Density Lipoprotein, LDL-C ԩ਒ཛྷ௟ࡪҺࠪ஧కϨ Rabbit Anti-human Thymocyte Globulin, RATG

ԩវّଵϋ Antibody-Mediated Rejection, AMR ֗វኳณ޽ᇴ Body Mass Index, BMI ‫ ૵ؠמ‬Certican

ௐ 7 ౢā͕᝙ொങ‫۞ޢ‬ᗁᒚ໰᜕ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ૱ϡ۞ԩଵϋᘽ‫ݡ‬ ܑ 7-1 ถአᒤᅕԺ‫ט‬጗ (calcineurin inhibitor)

΃ᔁԺ‫ט‬጗

1. າវ༙ (Sandimmun Neoral) 2. ೼ሄΞೇ (Prograf)

(metabolite inhibitor)

1. ொ᜕ှ (Imuran) 2. ̋ಈк (Cellcept)

ࣲ֯ᙷ࿩‫س‬ឣ৵࿯វ Ժ‫ט‬጗ (mammalian

1. ‫( ૵ؠמ‬Certican) 2. ϋঐី (Rapamune)

target of rapamycin [mTOR] inhibitor)

ᙷ‫׽‬ዔ (steroid)

1. ೼˧кှ (Predonin) 2. නѬ࡚‫מ‬Ҧ (Solu-Medrol)

ԩវ

1. ಏঀԩវĈາ༙ሄ (Simulect) 2. кঀԩវĈԩ਒ཛྷ௟ࡪҺࠪ ஧కϨ (Rabbit Anti-human Thymocyte Globulin, RATG)

˟ă έ̂ᗁੰ૱ϡ۞ԩଵϋᘽ‫ݡ‬ (˘) ᙷ‫׽‬ዔ 1. නѬ࡚‫מ‬Ҧ (Solu-Medrol) 1000 mg д͘ఙ̚ ‫ڦ‬डĞ500 mg ‫ڦ‬ˢௐ˘ఠ͕҉౫༑୵Ă 500 mg ‫ٺ‬ᕝᗓˠ͕̍۱፟‫ڦޢ‬डĂࡶ̙ϡ͕҉౫ ༑୵Ă‫݋‬д‫ٸ‬ฟ͹જਔӵ̄Ăฟؕ᛿‫͕ڦ‬᝙ ݈‫ڦ‬ड 1000 mgğ Ă൒‫ޢ‬ĂՏ 8 ̈ॡᐖਔ‫ڦ‬ड 120 mg ˬѨĄ

ௐ 7 ౢā͕᝙ொങ‫۞ޢ‬ᗁᒚ໰᜕ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Chou NK, Wang SS, Chen YS, et al. Induction immunosuppression with basiliximab in heart transplantation. Transplant Proc 2008;40:2623-5. 2. Wang SS, Chou NK, Chi NH, et al. Can cyclosporine blood level be reduced to half after heart transplantation? Transplant Proc 2010;42:930-3. 3. Wang SS, Chou NK, Chi NH, et al. Clinical experience of tacrolimus with everolimus in heart transplantation. Transplant Proc 2012;44: 907-9. 4. Wang CH, Chou NK, Wu LFL, et al. Influence of everolimus on cyclosporine Neoral pharmacokinetics in Chinese de novo cardiac transplant recipients. Transplant Proc 2006;38:2032-4. 5. Wang SS, Chou NK, Chi NH, et al. The survival of heart transplant recipients using cyclosporine and everolimus is not inferior to that using cyclosporine and mycophenolate. Transplant Proc 2010;42:938-9. 6. Wang SS, Chou NK, Chi NH, et al. Heart transplantation under cyclosporine or tacrolimus combined with mycophenolate mofetil or everolimus. Transplant Proc 2008;40:2607-8. 7. έ̂ᗁੰጡ‫ء‬ொങဥฤĄ͕᝙ொങ͘ఙᄲ‫ځ‬Ą‫פ‬ ҋ http://www.ntuhtx.org.tw/2014/5/20 8. Wang SS, Chu SH, Tsai CH, et al. Intraaortic balloon pump for myocardial failure in cardiac surgical patients. Acta Cardiol Sin 1993;9:218-23. 9. Wang SS, Chen YS, Ko WJ, et al. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Artif Organs 1996;20:1287-91.

101

͕᝙ொങ۞ ͕᝙Αਕᑭߤ

Ղୁ‫( ځ‬Chii-Ming Lee, M.D., Ph.D.) έ̂ᗁੰ̰ࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯᗁጯրઘି଱

ᙯᔣෟ (Keywords) ങវ݄‫ې‬જਔർ̼ Transplant arteriosclerosis ொങ͕ҕგঽត Cardiac allograft vasculopathy ͕҉௡ᖐ̷ͯ Endomyocardial biopsy ҕგ̰෹ࢰ‫ گ‬Intravascular ultrasound, IVUS ઼ᅫ͕۱ொങጯົ International Society of Heart and Lung Tansplantation, ISHLT

ާّԩវّଵϋ Acute antibody mediated rejection

106

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ͔֏ ͕᝙ொങ̝‫ޢ‬Ăତ‫צ‬۰ (recipient) ၆‫ٺ‬ങវ (graft) ΞਕயϠଵϋĂ‫̚׎‬၆‫ٺ‬ങវ͕҉۞ଵ ϋүϡ (muscular rejection) к൴Ϡ‫ٺ‬ொങ˘ѐͽ ̰Ă߇˫Ⴭ̝ࠎާّଵϋ (acute rejection)ć҃ ၆ ‫ ٺ‬ങ វ ݄ ‫ ې‬જ ਔ ۞ ଵ ϋ ү ϡ (vascular rejection) ٕჍࠎങវ݄‫ې‬જਔർ̼ (transplant arteriosclerosis) ٕ ͕ ᝙ Т ჌ ങ វ ҕ გ ঽ ត (cardiac allograft vasculopathy) ‫݋‬к൴Ϡ‫ٺ‬ொങ ˘ѐ̝‫ޢ‬Ă߇˫Ⴭࠎၙّଵϋ (chronic rejection)Ą ၆‫ّާٺ‬ଵϋ෧ᕝ۞เ‫ܛ‬ᇾ໤ (gold standard) ࠎ ͕҉௡ᖐ̷ͯᑭߤ (endomyocardial biopsy)ć҃ ၙّଵϋ۞னҖ෧ᕝᇾ໤‫ࠎ݋‬ҕგ̰෹ࢰ‫گ‬ (intravascular ultrasound, IVUS)Ă૟̶ࢗ‫˭ٺ‬Ą

˟ă ͕҉௡ᖐ̷ͯᑭߤ (˘) ዋᑕা Ϥ‫҉͕ٺ‬ଵϋр൴Ϡ‫͕ٺ‬᝙ொങ‫˘ޢ‬ѐ ̰Ă߇‫ٺ‬ொങ̝‫ืޢ‬ତ‫צ‬૜ะ۞͕҉௡ᖐ̷ͯ ᑭߤĄ˘ਠॡ඀ࢎ‫ٺ‬ொങ‫ޢ‬ௐ˟ăˬăαฉՏ ฉ˘ѨĂ‫ޢ׎‬Տ‫˘؞‬ѨĂ႕˘ѐ̝‫ޢ‬ՏѐซҖ ˘ѨĞܑ 8-1ğ Ą

116

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Stewart, S., et al., Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant, 2005. 24(11): p. 1710-20. 2. Berry, G.J., et al., The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation. J Heart Lung Transplant, 2013. 32(12): p. 1147-62. 3. Lee, C.M., et al., Intravascular ultrasound correlates with coronary flow reserve and predicts the survival in angiographically normal cardiac transplant recipients. Cardiology, 2008. 109(2): p. 93-8. 4. Wu, Y.W., et al., PET assessment of myocardial perfusion reserve inversely correlates with intravascular ultrasound findings in angiographically normal cardiac transplant recipients. J Nucl Med, 2010. 51(6): p. 906-12.

͕᝙ொങ‫۞ޢ‬ ঽநត̼

गछഏ (Shun,Chia-Tung, M.D., Ph.D.) έ̂ᗁੰঽநొ͹‫ڼ‬ᗁर ઼ϲᄂ៉̂ጯ‫ڱ‬ᗁጯࡊāି଱

ᙯᔣෟ (Keywords) ௟ࡪّଵϋ Cellular rejection ԩវಫّ̬ଵϋ Antibody-mediated rejection Quilty effect ྃវͯ߱ C4d

118

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ͕᝙ொങ‫ޢ‬ଵϋ 1. ଵϋ۞෧ᕝ͹ࢋያ͕҉̷ͯ (Endomyo-cardial biopsy; EMB) ᑭߤቁ‫ؠ‬෧ᕝĄ 2. ᇾώ۞఍ཉĈᅮҥͽ·̶۞ᓜԖܑனྤफ़Ă тொങ‫͇ޢ‬ᇴĂਖ਼ᑭ༊ॡ۞ᓜԖ‫ې‬ၗĄ 3. ˘ਠͽ͕ጱგӵΠ͕‫ ވ‬6 ͯẶͯͽ‫͞ؠ׽‬ё ਖ਼ᑭĂ 1 ͯͽາᔿᇾώਖ਼ᑭĄ։р۞‫ؠ׽‬ (10% Buffered Neutral Formalin)Ą

˟ă ҿ᝝ (˘) ็௚ H&E ҿ᝝ Β߁ଵϋѣ൑Ăѣ൑ӵࡍ‫͕ז‬γቯĄ

ဦ 9-1

͕᝙ொങ‫۞ޢ‬ ຏߖ఍ཉ

ग‫( ༽ض‬Hsin-Yun Sun) έ̂ᗁੰ̰ࡊొຏߖࡊ͹‫ڼ‬ᗁर ᄂ៉̂ጯᗁጯੰ̰ࡊāᓜԖӄநି଱

ᙯᔣෟ (Keywords) ͪ൰૲‫ې‬েৃঽ߲ Varicella-Zoster Virus, VZV λ௟ࡪঽ߲ Cytomegalovirus, CMV ಏ৷েৃঽ߲ Herpes-Simplex Virus, HSV ̕ልᖪঽ Toxoplasmosis ऱͩᐄᖪ Trypanosoma cruzi ‫ه‬঴ෂຏߖ Candidiasis ᔳ஧ෂຏߖ Cryptococcosis ۱ᝃᖪ۱‫ ۆ‬Pneumocystis pneumonia เᚌឣෂ Aspergillus ‫ܛ‬เҒཬ෈஧ෂ Staphylococcus aureus ˿ᚓ௟ෂຏߖ Nocardiosis ქᓘ୛ෂ Pseudomonas ඕ८ෂຏߖ Tuberculosis

͕᝙ொങ໰᜕͘Ί

126

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ߹Җঽጯ 1. ொങ‫ޢ‬ຏߖࠎ͕᝙ொങ‫ޢ‬ౄјѝഇ̈́୎ഇѪ ˸۞͹ࢋࣧЯ̝˘ (1, 2)Ą 2. ጡ‫ء‬ொങ‫ޢ‬ຏߖΞॲፂጡ‫ء‬ொങ‫ޢ‬ॡมк˳Ă ௖ர̶ࠎ˭ЕˬഇĂтܑ 10-1 ٙϯĈ (1) ͕᝙ொങ‫ޢ‬ѝഇĞ̈‫࣎͡˘ٺ‬ğ Ą (2) ͕᝙ொങ‫̱࣎͡ז˘ޢ‬Ą (3) ͕᝙ொങ‫( ̱࣎͡ٺ̂ޢ‬3)Ą ܑ 10-1 ጡ‫ء‬ொങ‫ޢ‬ຏߖ (3) ொങ‫࣎͡˘ٺ̈ޢ‬

ொങ‫̱࣎͡ז˘ޢ‬

ொങ‫̱࣎͡ٺ̂ޢ‬

໚‫ٺ‬ᗁੰ̰ٕ͘ఙ ࠹ᙯ۞ຏߖ

ሕЄّຏߖ۞ᖬ൴

໚‫ۤٺ‬ડ۞ຏߖ

ѣତ‫צ‬ԩঽ߲ (CMV,

ۤડّ۱‫ۆ‬ă ‫ک‬Ԍ྽‫ۆ‬

ԩᘽෂঀ࠹ᙯຏߖ

HBV) ̈́۱ᝃᖪ۱‫ۆ‬

࿰ّ֨ϡᘽ MRSA

BK к‫ݭ‬ሳঽ߲ຏߖ ٕ BK к‫ݭ‬ሳঽ߲࠹ ᙯඪঽঽ

เᚌឣෂăͨឣෂă ‫ݭ׏ܧ‬ឣෂຏߖ

VRE

ӧᙱୣ‫ې‬୛ෂབ‫ۆ‬

˿ᚓ௟ෂ (nocardia)ă ࡓ஧ෂ (rhodococcus

‫ ܧ‬albicans ̝ ‫ه‬঴ෂຏߖ

C ‫ݭ‬ք‫ۆ‬ຏߖ

ሕЄّঽ߲ຏߖ

๦ˢ

ཛྷঽ߲ຏߖ

λ௟ࡪঽ߲ຏߖĞབ‫ۆ‬ ٕෛშቯ‫ۆ‬ğ

ጱგ࠹ᙯຏߖ

ᔳ஧ෂຏߖ

ք‫( ۆ‬HBV, HCV)

species)

ᜈ˭ࢱ

134

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Hsu RB, Fang CT, Chang SC, Chou NK, Ko WJ, Wang SS et al. Infectious complications after heart transplantation in Chinese recipients. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 2005;5(8): 2011-2016. 2. Montoya JG, Giraldo LF, Efron B, Stinson EB, Gamberg P, Hunt S et al. Infectious complications among 620 consecutive heart transplant patients at Stanford University Medical Center. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2001;33(5): 629-640. 3. Fishman JA. Infection in solid-organ transplant recipients. The New England journal of medicine 2007;357(25):2601-2614. 4. Dummer JS, Singh N. Infections in solid organ transplant recipients. In: Mandell D, and Bennett’s, (ed). Principles and Practice of Infectious Diseases. Maryland Heights: Churchill Livingstone, 2009: 38393850. 5. Hsu RB, Chang CI, Fang CT, Chang SC, Wang SS, Chu SH. Bloodstream infection in heart transplant recipients: 12-year experience at a university hospital in Taiwan. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 2011;40(6):1362-1367. 6. Baldwin RT, Radovancevic B, Sweeney MS, Duncan JM, Frazier OH. Bacterial mediastinitis after heart transplantation. The Journal of heart and lung

̈‫͕׊‬᝙ொങ

เ३ઉ (Huang, Shu-chien MD, PhD.) έ̂ᗁੰ͕᝙ҕგγࡊ૞Ї͹‫ڼ‬ᗁर ઼ϲέ៉̂ጯᗁጯੰāᓜԖઘି଱

ᙯᔣෟ (Keywords) Аّ͇͕᝙ঽ Congenital Heart Disease ̈‫͕׊‬᝙ொങ Pediatric cardiac transplantation

138

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă͔֏ ௐ˘࣎јˠ͕᝙ொങߏд 1967 ѐ 12 ͡ 3 ͟Ϥ ‫ܧݑ‬ᗁर C.Barnard ၁߉Ăᇴฉ‫ޢ‬Ă Kantrowitz ಡ Ә˘Ҝ 16 ໐̈‫ޅ‬ѣˬыᘝ൴ֈ̙Бତ‫͕˞צ‬᝙ொ ങĄ 1969 ѐĂ઼࡚ᇇэ۞ Denton Cooley ࠎ˞˘࣎ ‫̰͕۞̂࣎͡׌‬ါቯ৿ຫᑈ‫ે׊‬Җ͕᝙ொങĄ 1984 ѐ઼࡚छΐэ Bailey ᗁरဘྏͽளវ‫̝غ‬ᰞ ᰞ͕᝙ொങ‫˘ٺ‬ᑈ‫׊‬Ă̖͔੓၆̈‫׊‬ᄃᑈ‫͕׊‬᝙ ொങ۞ࢦෛĄ 1985 L. Bailey ࢵּᑈ‫͕׊‬᝙ொങј ΑĄ͕᝙ொങன̏јࠎ̈‫׊‬ᚑࢦّАّ͇͕᝙ঽ ᄃ͕҉া̝ࢦࢋྋՙ͞‫ڱ‬Ą

˟ă ̈‫͕׊‬᝙ொങዋᑕা (˘) Аّ͇͕᝙়ঽ 1. ൑‫ڱ‬ᒣ‫۞ڼ‬Аّ͇͕᝙ů͹ࢋ੅ኢ۞ߏν͕ ൴ ֈ ̙ Б ۞ ‫ ڼ‬ᒚ (hypoplastic left heart syndrome) Β߁ Loma Linda University ൴ण۞ primary infant heart transplant ‫ ׶‬Norwood’s Stage reconstruction. ϫ݈Яࢦ‫͘ޙ‬ఙซՎ̈́ॕ ᙑ۰ྵ͌ ொങܲ঻ග͘ఙ‫̪ޢ‬൒͕਽ა۞ঽ ଈߏ͹߹ຍ֍Ą 2. Аّ͇͕᝙ঽᒣϒ‫͕ޢ‬᝙਽აĄ

150

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Canter CE, Shaddy RE, Bernstein D, et al. Indications for heart transplantation in pediatric heart disease: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Feb 6 2007;115(5):658-76. 2. ABO-incompatible heart transplantation: Analysis of the Pediatric Heart Transplant Study (PHTS) database J Heart Lung Transplant 2012;31:173-9 3. ABO-incompatible heart transplantation in early childhood: An international multicenter study of clinical experiences and limitsThe Journal of Heart and Lung Transplantation Volume 32, Issue 3, March 2013, Pages 285-292. 4. The Registry of the International Society for Heart and Lung Transplantation: Sixteenth Official Pediatric Heart Transplantation Report-2013; Focus Theme: Age The Journal of Heart and Lung Transplantation, Vol 32, No 10, October 2013.

͕᝙ொങ‫۞ޢ‬ ΐ᜕ঽ᜕ٗந

࿥̯า (Yun-Wen Yung, RN) έ̂ᗁੰ͕ҕგ͕̚ΐ᜕ঽ᜕ٗந‫ܜ‬

ᙯᔣෟ (Keywords) ΐ᜕᜕ந Intensive Care Unit nursing

͕᝙ொങ໰᜕͘Ί

152

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ତঽˠ݈໤౯ ͕᝙γࡊΐ᜕ಏҜ۞ಏˠঽٗАͽංᛖ‫ޢ‬ ۞႓Ϩͪᑡ޹ĂΩ૟ঽଈఙ‫ޢ‬ᅮֹϡ۞ϠநႾ ෛጡă‫ײ‬ӛጡ̈́ఙ‫ֹົޢ‬ϡ۞ᘽ‫ڦۏ‬डᑒ঒ඈ ጡ‫׍‬ซҖ඘γቢঐ߲Ă֭дঽٗγ‫ٸ‬ཉ࿣ᗓҗĄ ΐ᜕࿪જԖĈԖ৤७ϒăዛԖăԖ˯ᕇႍ ߛăజᄏĄ న‫ؠ‬ԖᙝϠநႾෛጡሀ௡ă‫ײ‬ӛጡ̈́‫΁׎‬ ᗁᒚ໰᜕ϡ‫ۏ‬໤౯Ĉ 1. EKG ă Pressure (A-L, CVP, PAP)ă SvO 2 ă C.O ă SpO2 Ă֭ቁᄮሀ௡ΑਕĄ 2. ‫ײ‬ӛጡă Ambu bag ă suction ϡ‫ۏ‬Ą 3. ਒ට͔߹ᑅ˧ณܑ (low pressure)Ą 4. Iv pump, IV stand Ą 5. N-G Tubë͔́߹ఠĂγࡊତგĞۡତƟYତğ Ą

˟ă ఙ‫۞ޢ‬ΐ᜕᜕ந໰᜕ࣧ‫݋‬ Ⴞീ͕᝙ҕგΑਕă௡ᖐ᛿߹̈́ᘦ‫۞ؠ‬Ϡ ‫׻‬ᇈ෪‫׶‬ຍᙊ‫ې‬ၗෞҤĂѣள૱ॡϲӈ఼ۢᗁ रĄ 1. ͕ྯిத̈́༼‫ޠ‬ 2. ҕᑅ

ௐ 12 ౢā͕᝙ொങ‫۞ޢ‬ΐ᜕ঽ᜕ٗந Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

3. ିጱঽˠ̈́͹ࢋ໰ᜪ۰ѣᙯ๋˾̝໰ᜪĂ̈́Ᏸ ᄮ๋˾ѣ൑Ъ‫׀‬াт̙ϒ૱̶‫ۏک‬ăࡓཚăᕽ Ъ̙։ඈଐԛ̈́࠹ᙯ఍ཉĄ 4. ฼ࢴ޽ጱĈҲៃăҲᓙ‫׽‬ዔ฼ࢴĄ

ણ҂३ϫ 1. Ѧፘጙ (1995)Ć͕᝙͘ఙ‫ޢ‬дΐ᜕‫۞̚ވ‬ᗁᒚĆέ ΔĈઉ૵̼͛Ą 2. ዑษᄼ (2007)ĆާাᗁጯĆέΔĈЪ੃Ą 3. ᄂ̂ᗁੰ᜕நొ ᜕நүຽఢቑ̈́໰᜕ᇾ໤Ą

161

͕᝙ொങ‫۞ޢ‬ঽٗ ໰᜕̈́‫ا‬छ᜕ந

୓็ِ (Chuan-I Tsao, RN) έ̂ᗁੰጡ‫ء‬ொങ‫ם‬አ᜕நर (transplant coordinator)

ᙯᔣෟ (Keywords) ଵϋ Rejection ᒛা Malignancy ຏߖ Infection ඪΑਕ̙Б Renal insufficiency ੻ኳழᗫ Osteoporosis ੼ҕ਌ Hyperlipidemia ੼ҕᑅ Hypertension ᎤԌঽ Diabetes mellitus ͕‫̙ޠ‬ፋ Arrhythmia ᄮۢ Cognitive ّΑਕ Sexual function ᘃθ Pregnant

164

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ொങఙ‫ޢ‬໰᜕͞ё ொങఙ‫۞ޢ‬໰ᜪဥฤ͹ࢋΒ߁ঽˠăछ ᛳă͹ࢋ໰ᜪ۰ă͕᝙ொങγࡊᗁϠă͕᝙ ࡊĂொങ‫ם‬አ᜕நरăۤ̍रăᒉዳरăೇ‫ޙ‬ र‫׶‬ᓜԖᘽरĄ Տ࣎ொങ͕̚ѣ̙Т۞໰᜕͞९Ăঽଈౌ ᅮ‫ؠ‬ഇ੠ᖸĂซҖ٩ҕ̈́࠹ᙯᑭߤĂႾീ͕᝙ ΑਕĂአፋԩଵϋᘽ፧‫̈́ޘ‬጗ณĂ఍நԩଵϋ ᘽ‫࠹ٕۏ‬ᙯᘽ‫͔ۏ‬੓̝ઘүϡඈĄ

ࢦࢋّ 1. ᒢྋঽˠனх̈́ሕдયᗟĂග̟ዋ༊໰᜕ᄃ ኎ି޽ጱćтொങ‫ޢ‬Ъ‫׀‬াĞຏߖăଵϋă ݄‫ې‬જਔҕგঽត‫׶‬ೋّཚሳğ̈́ఙ‫ޢ‬Ъ‫׀‬ াĞтᎤԌঽă੼ҕᑅă੼਌ҕাٕ੻ኳழ ᗫğඈયᗟĄ 2. ೩ ֻ ᓜ Ԗ ᜕ ந र ໰ ᜪ ͕ ᝙ ொ ങ ఙ ‫ ޢ‬ঽ ˠ ࢋ ᕇĂԓਕྋՙᓜԖ‫ٕڶې‬ᅮՐĂਕॲፂଈ۰ ۞ᅮՐ೩ֻّ̼࣎۞໰ᜪĄ

186

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Costanzo, M. R., Costanzo, M. R., Dipchand, A., Starling, R., Anderson, A., Chan, M., ... & Hosenpud, J. (2010). The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. The Journal of Heart and Lung Transplantation, 29(8), 914-956. 2. International Transplant Nurses Society. Patient’s Guide to Heart Transplant Surgery. Retrived May 6,2014,from http://www.cts.usc.edu/ht-patientguide. html. 3. University of south California keck school of medicine. Patient’s Guide to Heart Transplant Surgery.Retrived May 6, 2014, from http://www.cts. usc.edu/ht-patientguide.html. 4. U p t o d a t e Ĉ a r r h y t h m i a s - f o l l o w i n g - c a r d i a c transplantation. Retrived May 6,2014,from http:// www.uptodate.com/contents/arrhythmias-followingcardiac-transplantation. 5. Sandra A. Cupples, Linda Ohler (2003). Transplantation Nursing Secrets. 6. ୓็ِ (2014)Ą͕᝙ொങঽଈ۞ҋԧܲઉĄྶ‫ͳٺ‬ ͪஎă‫׹‬੝ᆵĞ͹በğ Ăጡ‫ء‬ொങę൴னયᗟăವ ՐྋඍĞ59-74 ࢱğ ĄᄂΔξĈЪ੃Ą 7. ᄂ̂ᗁੰ͕᝙ொങဥฤ (2000)Ą͕᝙ொങĄέΔ ξĈᄂ̂ᗁੰ͕᝙ҕგγࡊĄ

͕᝙ொങ݈‫۞ޢ‬ ྻજ੊ቚ

ౘ‫ޥ‬ᅈ (Ssu-Yuan Chen, MD, PhD) έ̂ᗁੰೇઉొ͹‫ڼ‬ᗁर ᄂ៉̂ጯᗁጯੰᗁጯրೇઉࡊӄநି଱

Ꮒ୿‫۾‬ăӕׂৌăѯᴣጙ ‫ۏ‬ந‫ڼ‬ᒚर

ᙯᔣෟ (Keywords) ˟উ̼჆ೱঈ༊ณ Ventilatory equivalent of carbon dioxide

͕۱࡝˧ Cardiorespiratory fitness ͕᝙ೇઉ Cardiac rehabilitation ҉˧ Muscle strength ѣউྻજ Aerobic exercise ҋᛇϡ˧ܼᇴ Rating of preserved exertion ֗វ߿જ Physical activity ‫੊˧ܡ‬ቚ Resistance training ߦॾͩҋᛇϡ˧ܼᇴ Borg scale જᐖਔҕউम Arteriovenous oxygen difference ౵̂ྻજ͕۱Αਕീྏ Cardiopulmonary exercise testing ౵̂ᛷউณ Maximal oxygen uptake ྻજ੊ቚ Exercise training ᙯ༼ྻજ Range of motion exercise

188

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ͔֏ ˘ਠ҃֏Ăତ‫͕צ‬᝙ொങঽˠ۞Ϡ߿‫ݡ‬ኳ ‫إ‬ΞĂΞаೇ̂кᇴ۞͟૱Ϡ߿̈́̍үĂҭវ ਕ̪ͧТѐ᛬ൾमĄ͕҃᝙ொങఙ‫͕۞ޢ‬᝙ೇ ઉྻજ੊ቚΞͽѣड़۞ᆧซଈ۰۞វਕ̈́Ϡ߿ ‫ݡ‬ኳĄѩγĂனѣ̝ࡁտᙋፂពϯఢ‫ྻޠ‬જѣ ৈઉ૵ĂΞࢫҲ͕᝙ঽѪ˸۞ПᐍĂഴ͌ᎤԌ ঽă੼ҕᑅă̂བᒛඈ۞൴ϠĂ‫ם‬ӄଠ‫ט‬វ ࢦĂჯ޺ઉ૵۞੻ᐪă҉҇ᄃᙯ༼Ăഴ͌ᇎ៭ ̈́൏ᇋĂͽ̈́ᆧΐ‫ض‬჊ຏćఢ‫ྻ۞ޠ‬જΞͽԼ චҕგർ̼̈́ҕგ̰ϩ௟ࡪΑਕăࢫҲҕᑅ̈́ ਍फ৵‫ܡ‬ԩăԼචҕ୵ᕆ႖ّ̈́ഴ͌ং๫ăഴ ͌ҕ਌۹ள૱͕̈́‫̙ޠ‬ፋĂซ҃ഴ݄͌‫ې‬જਔ ͕ҕგ়ঽ۞൴Ϡ̈́Ѫ˸தĄЯѩĂ͕᝙ೇઉ ၆‫͕ٺ‬᝙ொങঽˠߏ‫ܧ‬૱ࢦࢋ۞Ą

˟ă ͕᝙ொങ݈۞ྻજ੊ቚ ͕᝙ொങ͘ఙ݈۞ଈ۰Ăкᇴ‫͕ࢨצ‬᝙਽ აা‫ې‬ጱ࡭̝֗វ߿જਕ˧‫̈́ࢨצ‬Ϡ߿‫ݡ‬ኳ˭ ࢫĄ‫ܕ‬ѐֽధкࡁտᙋ၁Ăঽଐᘦ‫͕۞ؠ‬᝙਽ აঽˠĂགྷ࿅૞ຽෞҤ‫ޢ‬ତ‫ߏצ‬ΞͽщБгତ ‫ྻצ‬જ੊ቚĂซ҃Լච‫ྻ׎‬જ࡝˧ăഴ͌া‫ې‬ ͽ̈́೩̿֗߿‫ݡ‬ኳĄ

ௐ 14 ౢā͕᝙ொങ݈‫ྻ۞ޢ‬જ੊ቚ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Chen SY, Lan C, Ko WJ, et al. Cardiorespiratory response of heart transplantation recipients to exercise in the early postoperative period. Journal of the Formosan Medical Association 1999;98(3):165-70. 2. Squires RW. Exercise therapy for cardiac transplant recipients. Prog Cardiovasc Dis 2011;53(6):429-36. 3. Keteyian SJ. Exercise training in congestive heart failure: risks and benefits. Prog Cardiovasc Dis 2011;53(6):419-28. 4. Hsu CJ, Chen SY, Su S, et al. The effect of early cardiac rehabilitation on health-related quality of life among heart transplant recipients and patients with coronary artery bypass graft surgery. Transplantation Proceedings 2011; 43(7):2714-2717. 5. Chen SY, Lu PJ, Lan C, et al. Six-minute walk test among heart transplantation recipients. Transplantation Proceedings 2014; 46 (3): 929-933.

203

͕᝙ொങ۞ჟৠ ࡊ໰ົᓑથĈ Бˠ໰᜕۞ར၁

Ղ‫ځ‬ᑺ (Ming-Been Lee) ᄂ̂ᗁጯੰჟৠࡊି଱ ᄂ̂ᗁੰჟৠᗁጯొ͹‫ڼ‬ᗁर

ၐ̀඀ (Shih-Cheng Liao) ᄂ̂ᗁੰჟৠᗁጯొ͹‫ڼ‬ᗁर

ᙯᔣෟ (Keywords) ჟৠࡊ໰ົᓑથ Consultation-liaison psychiatry

206

͕᝙ொങ໰᜕͘Ί Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ͔֏ ᄂ̂ᗁੰჟৠᗁጯొ͕֗ᗁጯဥฤĂҋώ ੰௐ˘ּ͕᝙ொങ࣎९ฟؕĂӈͽᓑથ (liaison) ‫ڇ‬ચ͞ёણᄃொങ݈͕֗ᗁጯෞҤͽ̈́ொങఙ ‫͕ົۤޢ‬நዋᑕ੠ᖸ‫ڇ‬ચĂซ҃ͽ໰ົ (consultation) ‫ڇ‬ચ͞ё޺ᜈᄃொങဥฤЪүĂ ͽВТར၁Бˠ໰᜕ந‫ه‬Ąώ่͛ͽጡ‫ء‬ொങ ᄃჟৠࡊ࠹ᙯ‫ޠڱ‬ă͕᝙ொങ࠹ᙯჟৠࡊ૱֍ યᗟă໰ົᓑથჟৠᗁጯд͕᝙ொങဥฤԷႊ ̝֎ҒඈࢬШĂᖎ̬͕᝙ொങ۞ჟৠࡊ໰ົᓑ થ‫ڇ‬ચ̝̰टᄃໄ‫ڶ‬Ą

˟ă ጡ‫ء‬ொങᄃჟৠࡊ࠹ᙯ‫ޠڱ‬ (˘) ˠវጡ‫ء‬ொങ୧ּ Ğ࣒ϒ͟ഇϔ઼ 100 ѐ 12 ͡ 21 ͟ğ ௐ 8 ୧Ğ༼ᐂğĈᗁੰҋ߿វၡ‫פ‬ጡ‫߉ء‬Җ ொങ͘ఙĂᑕ၆ॕᙑ۰̟ͽྎ௟Ԇፋ̝͕ நăۤົăᗁጯෞҤĂགྷෞҤඕ‫ڍ‬ዋЪॕ ᙑĂͷд൑ᑅ˧˭̈́൑Їң‫ܛ‬᏿ٕ၆ᆊ̝ Ϲ‫ٽ‬ҖࠎĂҋᙸॕᙑጡ‫ء‬Ă֭೩གྷ‫׎‬ᗁጯ ࣖந؎ࣶົᆶߤ఼࿅Ăؕ଀ࠎ̝Ą

ௐ 15 ౢā͕᝙ொങ۞ჟৠࡊ໰ົᓑથĈБˠ໰᜕۞ར၁ Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

ણ҂३ϫ 1. Ղ ‫ ځ‬ᑺ Ĉ ͕ ᝙ ொ ങ Ą ᗁ ጯ ۞ ˠ ّ ࢬ ů ଐ ჰ ᄃ ় ঽĂௐˬ˩˝ౢĄέ̂ᗁጯੰᗁጯ΍‫ۍ‬Ą‫ܛ‬Щဦ ३̳ΦОҖĄᄂΔξĂ 2003 Ą 2. ౘߍⷓăՂ‫ځ‬ᑺă‫ܘ‬ዩጰăၐ̀඀ăՂц‫أ‬ăഅ ࡚ംăӓָ⮒Ĉ͕᝙ொങଈ۰̝ჟৠ়ଈ̈́࠹ᙯ ͕நۤົপኳĄΔξᗁጯᗔᄫ 2004 ć 1 ‫ ס‬2 ഇĂ P179-188 Ą 3. ཧࡻ㠙ăၐ̀඀Ĉ໰ົჟৠᗁጯĄ‫ٺ‬Ղ‫ځ‬ᑺበ඾Ĉ ၁ϡჟৠᗁጯĂௐˬ‫ۍ‬Ăௐˬ˩ˬౢĄέ̂ᗁጯ ੰ΍‫ۍ‬Ą‫ܛ‬Щဦ३̳ΦОҖĄᄂΔξĂ 2011 Ą

213

͕᝙ொങᑭរี ϫ̈́‫׎‬ᓜԖຍཌྷ

16 ͨ̈ᓧ

έ̂ᗁੰᑭរᗁጯొઘ͹Ї

ң୿ಬ ঽ߲ᑭរ௡௡‫ܜ‬

ᆒЏઈ Ϡ̼ᑭរ௡௡‫ܜ‬

ᆒ೺ำ Ꮾҕၱொങᑭរ௡௡‫ܜ‬

ᖎຎᆇ ღާᑭរ௡௡‫ܜ‬

͕᝙ொങ໰᜕͘Ί

216

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

Ŏώౢ༼ྤफ़‫פ‬ҋᑭរᗁጯొ۞ᑭរϫᐂ

˘ă ૄώีϫ ีϫ

ᑭរ͞‫ڱ‬

ᓜԖຍཌྷ

ϨకϨ

ͧҒ‫ڱ‬

1. ϨకϨ፧‫ࢫ˭ޘ‬Ĉ

(Albumin, ALB)

(colorimetry)

acute/chronic inflammatory diseases, cirrhosis, nephrotic syndrome, malnutrition or malabsorption, Crohn’s disease, burns, congestive heart failure, thyrotoxicosis, ‫΁׎‬Ą

2. ϨకϨ፧‫̿˯ޘ‬Ĉ dehydration/hemoconcentration should be considered. ืЪ‫΁׎׀‬

ᓜԖᑭߤͽҿ᝝Ą ែّᒤᅕ ᅔ৵ (Alkaline phosphatase, ALP)

ͧҒ‫ڱ‬

1. ALP ˭ࢫĈ

(colorimetry)

malnutrition, hypothyroidism, Celiac sprue, milk alkali, others. 2. ALP ˯̿Ĉ Liver diseases (e.q. biliary disease, infiltrative liver disease, space occupying liver disease), bone disease (e.g. bony metastases, Paget’s disease), others. ืЪ‫׀‬

‫΁׎‬ᓜԖᑭߤͽҿ᝝Ą

‫ܢ‬ᐂ

˘ăˠវጡ‫ء‬ொങ୧ּ ˟ăˠវጡ‫ء‬ொങ୧ּ߉Җ௟‫݋‬ ˬăཝѪҿ‫ؠ‬୧ּ ‫ ܑܢ‬1 ‫ ܑܢ‬2 ‫ ܑܢ‬3 αă‫ގ‬វጡ‫ء‬ॕᙑ۰൳ᐂܑॾ ̣ă͕᝙ொങඈ࣏۰൳ᐂܑॾ ̱ă͕᝙ொങ࣎९੠ᖸܑॾ ˛ăᄂ̂ᗁੰ኎ିಏૺ (˘) ͕᝙ொങ͘ఙᄲ‫ځ‬३ (˟) ͕᝙ொങఙ‫۞ޢ‬૱֍ᑭߤ (ˬ) ͕᝙ொങఙ‫ޢ‬΍ੰ኎ି޽ጱ

͕᝙ொങ໰᜕͘Ί

248

Ъ੃ဦ३΍‫ ۤۍ‬൴Җ

˘ă ˠវጡ‫ء‬ொങ୧ּ Ğϔ઼ 100 ѐ 12 ͡ 21 ࣒͟ϒğ http://law.moj.gov.tw/LawClass/LawAll.aspx?PCo de=L0020024

Ğ‫ࢭڻ‬ğ 1. ̚රϔ઼˛˩̱ѐ̱͡˩˝͟ᓁ௚΄‫̳ؠט‬ ο 2. ̚රϔ઼ˣ˩˟ѐ̣͡˟˩˘͟ᓁ௚΄࣒ϒ ̳οௐ 8 ă 16 ~ 18 ୧୧͛ 3. ̚රϔ઼˝˩˘ѐ˛͡˩͟ᓁ௚රᓁ˘ཌྷф ௐ 09100137790 ཱི΄࣒ϒ̳οௐ 3 ă 6 ă 8 ~ 10 ă 14 ă 16 ~ 18 ă 20 ~ 22 ୧୧͛ć֭ᆧࢎ ௐ 1-1 ă 10-1 ă 18-1 ୧୧͛ 4. ̚රϔ઼˝˩˟ѐ˘͡˟˩˝͟ᓁ௚රᓁ˘ ཌྷфௐ 09200015230 ཱི΄ᆧࢎ̳οௐ 8-1 ă 14-1 ă 16-1 ୧୧͛ 5. ̚රϔ઼˘Ѻѐ˩˟͡˟˩˘͟ᓁ௚රᓁ˘ ཌྷфௐ 10000283861 ཱི΄࣒ϒ̳οௐ 6 ă 101 ă 11 ୧୧͛ ̚රϔ઼˘Ѻ࿬˟ѐ˛͡˩˝͟Җ߆ੰੰᄂ ఢфௐ 1020141353 ཱི̳Әௐ 1 ୧̝ 1 ٙЕᛳ ĶҖ߆ੰ኎Ϡཌķ̝ᝋయְีĂҋ˘Ѻ࿬˟ѐ ˛͡˟˩ˬ͟੓ԼϤĶ኎Ϡ჊Ӏొķგᔑ

৶͔

͛̚৶͔ ˘൪ ˘উ̼ധ Nitric oxide (NO) 70

˟൪ ˟উ̼჆ೱঈ༊ณ Ventilatory equivalent of carbon dioxide 196, 198 ˠᙷϨҕ஧ԩ̶ࣧ‫ ݭ‬HLA-A ă B ă C ă DR ă DQ 239 ˠᙷҺࠪ৿ౝঽ߲ Human Immunodeficiency Virus, HIV 28, 32, 127, 233 ˠវጡ‫ء‬ொങ୧ּ Human Organ Transplantation Act, HOTA 4, 35-42, 45-46, 206-207, 248, 258, 263

ˬ൪ ˬᅕϟ‫ڵ‬਌ Triglyceride, TG 83, 97, 180, 221 ˿ᚓ௟ෂຏߖ Nocardiosis 126, 127 ̈‫͕׊‬᝙ொങ Pediatric cardiac transplantation 138, 141, 144146, 148-149 ̋ಈк Cellcept 77, 82, 85-86, 89 ̕ልᖪঽ Toxoplasmosis 127

α൪ ๋̙चࣧ‫ ݋‬The Principle of Nonmaleficence 39, 41 ͕̚ᐖਔᑅ Central venous pressure, CVP 31, 66, 153, 190 ̳πϒཌྷࣧ‫ ݋‬The Principle of Justice 39-40, 42 ̶̄ᑭរԫఙ Molecular technology 239 ̶੨ࣧ‫ ݋‬Allocation 17, 21 ̼ጯҽЍҺ̶ࠪ‫ڱژ‬ Chemiluminescence immunoassay 233-236 ̼ጯҽЍ຋௕Һ̶ࠪ‫ڱژ‬ Chemiluminescent microparticle immunoassay 233 ͇‫ܝ‬΋῔ᅕᖼ῔ᅔ৵ Aspartate aminotransferase 230 ͕҉୊ᖼకϨ I Troponin I 228 ͕҉௡ᖐ̷ͯ Endomyocardial biopsy 61, 106-108 ͕ٗᚭΑਕ̙։ Sinoatrial node dysfunction 73 ͕۱࡝˧ Cardiorespiratory fitness 192-193, 197 ͕‫ވ‬ᅃӄጡ Ventricular assist device, VAD 5-8, 12, 19, 21-22,