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
急症护理研究

经体外膜肺氧合救治肝移植术后混合性休克患者的护理

  • 孙婷婷 ,
  • 谷茜 ,
  • 吴璟奕 ,
  • 王晓丽 ,
  • 王枫
展开
  • 200025 上海市 上海交通大学医学院附属瑞金医院重症医学科
孙婷婷:女,本科(硕士在读),护师,E-mail:stt02k69@rjh.com.cn
*王枫,E-mail:wf20742@rjh.com.cn

收稿日期: 2025-09-10

  网络出版日期: 2026-02-02

基金资助

上海交通大学医学院附属瑞金医院[RJKH(2)-2025-004]

Nursing care of a patient complicated with mixed shock after liver transplantation treated by extracorporeal membrane oxygenation

  • SUN Tingting ,
  • GU Qian ,
  • WU Jingyi ,
  • WANG Xiaoli ,
  • WANG Feng
Expand
  • Department of Intensive Care MedicineRuijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200025, China

Received date: 2025-09-10

  Online published: 2026-02-02

Supported by

Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine [RJKH(2)-2025-004]

摘要

总结1例自身免疫性肝炎患者肝移植术后并发混合性休克行体外膜肺氧合治疗的护理体会。针对该患者严重混合性休克、重要脏器严重灌注不足等问题,采取目标导向的循环复苏策略、体外支持精准化管理与器官灌注优化、基于血药浓度监测的免疫治疗管理以及多维屏障构建与溯源感染防控方案等措施。患者住院第29天病情稳定转入普通病房,住院共77 d顺利出院。出院后随访1个月状况良好。

本文引用格式

孙婷婷 , 谷茜 , 吴璟奕 , 王晓丽 , 王枫 . 经体外膜肺氧合救治肝移植术后混合性休克患者的护理[J]. 中华急危重症护理杂志, 2026 , 7(2) : 193 -196 . DOI: 10.3761/j.issn.2096-7446.2026.02.010

Abstract

To summarize the nursing experience of a case of mixed shock after liver transplantation for autoimmune hepatitis treated with extracorporeal membrane oxygenation. In response to problems such as severe mixed shock and critical organ hypoperfusion,the following nursing measures were implemented,including targeted circulatory resuscitation strategies,precise management of extracorporeal support and organ perfusion optimization,immunotherapy management based on therapeutic drug monitoring,and multi-dimensional barrier construction with infection prevention and control protocols. The patient was transferred to a general ward on the 29th day of hospitalization with stable condition and was discharged smoothly after 77 days of hospitalization. The patient was in good condition during the one-month follow-up after discharge.

参考文献

[1] Muratori L, Lohse AW, Lenzi M. Diagnosis and management of autoimmune hepatitis[J]. BMJ, 2023, 380:e070201.
[2] 中华医学会肝病学分会. 自身免疫性肝炎诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1):42-49.
  Hepatology Branch of Chinese Medical Assocation. Guidelines for diagnosis and treatment of autoimmune hepatitis(2021)[J]. J Clin Hepatol, 2022, 38(1):42-49.
[3] 管向东, 司向. 休克定义及分型的再思考[J]. 协和医学杂志, 2019, 10(5):438-441.
  Guan XD, Si X. Rethinking the definition and classification of shock[J]. Med J Peking Union Med Coll Hosp, 2019, 10(5):438-441.
[4] Jentzer JC, Berg DD, Chonde MD, et al. Mixed cardiogenic-vaso-dilatory shock:current insights and future directions[J]. JACC Adv, 2024, 4(1):101432.
[5] 中国心胸血管麻醉学会, 中华医学会麻醉学分会, 中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版)[J]. 中国循环杂志, 2020, 35(11):1052-1063.
  China Cardiothoracic Vascular Anesthesiology Society, et al. Expert consensus on clinical application of extracorporeal membrane oxygenation in adults under different conditions(2020 edition)[J]. Chin Circ J, 2020, 35(11):1052-1063.
[6] 李旭琴, 黄昉芳, 俞超. 致命性肺血栓栓塞症患者高出血风险下行体外膜肺氧合的护理[J]. 中华急危重症护理杂志, 2025, 6(4):462-465.
  Li XQ, Huang FF, Yu C. Nursing care of extracorporeal mem-brane oxygenation in patients with fatal pulmonary thromboem-bolism at high bleeding risk[J]. Chin J Emerg Crit Care Nurs, 2025, 6(4):462-465.
[7] 北京市体外生命支持质量控制和改进中心/首都医科大学附属北京安贞医院心脏外科危重症中心, 张倩倩, 杜桂芳, 等. 成人体外膜肺氧合循环辅助护理专家共识[J]. 中华急危重症护理杂志, 2025, 6(1):70-75.
  Beijing Extracorporeal Life Support Quality Control and Impro-vement Center/Cardiac Surgery Critical Care Center of Beijing Anzhen Hospital Capital Medical University,Zhang QQ, Du GF, et al. Expert consensus on auxiliary nursing care of adult extracorporeal membrane oxygenation[J]. Chin J Emerg Crit Care Nurs, 2025, 6 (1):70-75.
[8] 中国医师协会体外生命支持专业委员会, 山东省医师协会体外生命支持专业委员会. 中国成人经股动脉VA-ECMO治疗期间下肢缺血防治专家共识(2023)[J]. 中华危重病急救医学, 2023, 35(8):785-792.
  Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association,Extracorporeal Life Support Profes-sional Committee of Shandong Provincial Medical Doctor Asso-ciation. Expert consensus on prevention and treatment of lower limb ischemia during transfemoral veno-arterial extracorporeal membrane oxygenation therapy in adults in China[J]. Chin J of Crit Care Med, 2023, 35(8):785-792.
[9] Yongwei Yu, Xing Fang, Zhipeng Xu, et al. To identify Harle-quin syndrome in patients with venoarterial extracorporeal mem-brane oxygenation using radial near-infrared spectroscopy[J]. Crit Care, 2024, 28(1).
[10] 王岩, 王哲芸, 赵玮玮, 等. 1例主动脉夹层术后并发心源性休克行体外膜肺氧合患者的撤机护理[J]. 中华护理杂志, 2023, 58(16):1996-1999.
  Wang Y, Wang ZY, Zhao WW, et al. Nursing care for weaning from extracorporeal membrane oxygenation in a patient with postoperative aortic dissection complicated by cardiogenic shock[J]. Chin J Nurs, 2023, 58(16):1996-1999.
[11] Tu ZH, Jin PB, Chen DY, et al. Infection evaluation in the early period after liver transplantation:a single-center explora-tion[J]. Transpl Infect Dis, 2023, 25(2):e14002.
[12] 谷茜, 黄玺, 施伟雄, 等. 1例T细胞免疫治疗后并发细胞因子释放综合征患者的护理[J]. 中华护理杂志, 2025, 60(9):1124-1127.
  Gu Q, Huang X, Shi WX, et al. Nursing care of a patient with cytokine release syndrome after T cell immunotherapy[J]. Chin J Nurs, 2025, 60 (9):1124-1127.
文章导航

/