ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 ›› 2026, Vol. 7 ›› Issue (10): 1209-1211.doi: 10.3761/j.issn.2096-7446.2026.10.008

• 急症护理研究 • 上一篇    下一篇

肾移植术后并发自发性肝破裂致失血性休克患者的急救护理

姜巧玲(), 陆婷, 冯丽丽, 孙黎, 韩志坚, 周月红*()   

  1. 南京医科大学第一附属医院泌尿外科 南京市 210029
  • 收稿日期:2026-01-20 出版日期:2026-10-10 发布日期:2026-10-14
  • 通讯作者: *周月红，E-mail：82038159@qq.com
  • 作者简介:姜巧玲：女，本科，主管护师，E-mail：37646864@qq.com
    作者贡献声明

    姜巧玲：临床护理、资料收集、论文撰写；陆婷、冯丽丽：临床护理实施、数据整理、论文修改；孙黎：诊疗实施、病例分析讨论；韩志坚：诊疗策略、论文指导；周月红：总体设计、质量监督

  • 基金资助:
    江苏省医学重点学科/实验室(ZDXK202289)

Emergency nursing for a patient with hemorrhagic shock caused by spontaneous liver rupture after kidney transplantation

JIANG Qiaoling(), LU Ting, FENG Lili, SUN Li, HAN Zhijian, ZHOU Yuehong*()   

  1. Urology Department， the First Affiliated Hospital of Nanjing Medical University， Nanjing 210029， China
  • Received:2026-01-20 Online:2026-10-10 Published:2026-10-14
  • Contact: *ZHOU Yuehong，E-mail：82038159@qq.com
  • Supported by:
    Jiangsu Provincial Medical Key Discipline/Laboratory(ZDXK202289)

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摘要：

总结1例肾移植术后并发自发性肝破裂致失血性休克患者的急救护理体会。针对该并发症在肾移植受者中极为罕见、早期鉴别困难、救治中面临休克复苏与肾功能保护相矛盾、凝血紊乱与免疫抑制剂血药浓度稳定相制约、免疫抑制与多管路感染风险相叠加的多重挑战，采取以下措施：以护士为主导启动多学科团队并快速响应，落实休克鉴别措施；以“移植肾灌注安全窗”为核心分阶段实施容量管理，平衡复苏与移植肾的功能保护；基于凝血功能动态监测行阶梯式输血，精准纠正凝血功能障碍；强化他克莫司血药浓度监测，预防药物毒性；“时空分区”感染防控，降低多管路感染风险；针对患者听力下降，开展多模式沟通与智能随访延续性护理。通过系统化干预，患者成功度过危险期，术后第43天康复出院；术后3个月随访，移植肾功能正常（血肌酐107 μmol/L），肝功能正常。

关键词: 肾移植, 肝破裂, 休克, 出血性, 急症护理, 康复护理

Abstract:

To summarize the nursing of a patient with spontaneous liver rupture and hemorrhagic shock after kidney transplantation. Given the rarity，early diagnostic difficulty，and multiple dilemmas（shock resuscitation vs. renal protection，coagulopathy vs. immunosuppressant blood drug concentration stability，immunosuppression vs. infection risk of multiple catheters），we implemented nurse-led multidisciplinary rapid response for clarifying shock identification measures，staged volume management with the "transplant kidney perfusion safety window" as the core to balance resuscitation and functional protection of the transplant kidney，stepwise transfusion based on dynamic coagulation monitoring to precisely correct coagulation dysfunction，strengthening the monitoring of tacrolimus blood drug concentration to prevent drug toxicity，“space-time zoning” infection prevention and control to reduce the risk of multi-channel infection. For the patient with hearing loss，multi-mode communication and intelligent follow-up continuous care were implemented. Through systematic intervention，the patient survived the critical phase，was discharged on postoperative day 43，and had normal graft（serum creatinine 107 μmol/L） and liver function at 3 month follow-up.

Key words: Kidney Transplantation, Liver Rupture, Shock, Hemorrhagic, Emergency Nursing, Rehabilitation Nursing