总结1例终末期肝病合并肾功能不全患者在同种异体肝移植手术中连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的护理经验。护理要点包括:根据手术室感染控制要求进行上机操作;采用预冲有抗凝+治疗无抗凝的治疗护理方案;无肝期根据重点监测指标变化及时调整治疗参数;分析报警类型,建立报警预处理流程。最终患者手术7 h,CRRT总治疗时间9 h,过程顺利。
To summarize the nursing experience of a patient with end-stage liver disease and renal insufficiency who underwent continuous renal replacement therapy (CRRT) during allogeneic liver transplantation. The nursing key points include operating the machine compliant with the aseptic requirements in operating room, adopting a nursing plan for pre-flushing with anticoagulant and treatment without anticoagulant, timely adjusting treatment parameters according to the changes of key monitoring indicators during anhepatic phase, and analyzing the type of alarms and establishing a procedure for preprocessing an alarm. The patient underwent a liver transplantation surgery for 7 hours, and the total treatment time for CRRT was 9 hours with a smooth disease course.
[1] Umbro,Francesca I,Scalera T,et al.Acute kidney injury and post-reperfusion syndrome in liver transplantation[J].World J Gastroenterol,2016, 22(42):9314-9323.
[2] Siniscalchi A,Gamberini L,Laici C, et al.Post reperfusion syndrome during liver transplantation:From pathophysiology to therapy and preventive strategies[J].World J Gastroenterol,2016,22(4):1551-1569.
[3] 蒋建强.术前Child分级、微血管侵犯与原发性肝癌同种异体肝移植患者预后的相关性[J].中国卫生工程学,2020,19(10):775-776.
[4] 李丽珍.PCDA管理模式在消毒供应中心外来器械中的应用[J].护理研究,2017,31(10):1277-1278.
[5] 陈香美,主编.血液净化标准操作规程[M].(2021版).北京:人民卫生出版社,2021:124.
[6] 卢露,卢芳艳,张婉莹,等.1例肝豆状核变性并发肾功能衰竭患儿行肝移植术的护理[J].中华护理杂志,2022,57(2):208-211.
[7] 陈江华.连续性肾脏替代治疗的抗凝管理指南[J].中华肾脏病杂志,2022,38(11):1016-1022.
[8] 梅长林.抗凝技术在危重症肾脏替代治疗应用的中国专家共识(2023版)[J].中华肾脏病杂志,2023,39(2):155-164.
[9] 李克佳,付月亿,王欢,等.连续性肾脏替代治疗体外循环凝血的影响因素及预防对策研究[J].中国血液净化,2018,17(20):129-132.
[10] Vander-Voort P,RT Gerritsen,MA Kuiper, et al.Filter run time in CVVH:pre-versus-dilution and nadroparin versus regional heparin-protanmine anticoagulation[J].Blood Purif,2005,23(3):175-180.
[11] Challener D , Frank R , Kashani K ,et al.Body temperature trends of critically Ill patients on continuous renal replacement therapy: A single-center retrospective study[J].The American Journal of the Medical Sciences, 2022,364(4):404-408.
[12] 谭齐贤.临床血液学和血液检验[M].北京:人民卫生出版社,2005:288-291.
[13] 刘海迎,沈悦好,马艳秋,等.1例肾衰竭行血液透析治疗并发心搏骤停患者的护理[J].中华护理杂志,2022,57(21):2592-2595.
[14] 付平,主编.连续性肾脏替代治疗[M].(2016版).北京:人民卫生出版社,2016:333-335.
[15] 赵君花,卢燕,丁琳,等.3518例次CRRT治疗故障报警原因分析及指导[J].中国血液净化,2014,13(4):353-354.
[16] 金其庄,王玉柱,叶朝阳. 中国血液透析用血管通路专家共识(第2版)[J].中国血液净化,2019,18(06): 365-381.
[17] 孙晓美,余丽萍,杨金芳等.两种抗凝方法在消化道出血患者连续性肾脏替代治疗中的效果评价[J].江苏医药,2003,39(19):2369-2370.
[18] Baldwin I,Fealy N.Nursing for renal replacement therapies in the intensive care unit :historical,educational,and protocol review[J].Blood Purif,2009,27(2):174-181.