总结1例行胸腔镜手术的肺癌患者术中并发肺动静脉血管破裂致大出血、术中急转双侧开胸手术的急救护理体会。针对术中突发情况、病情进展迅速,立即成立抢救团队且合理分工,有序开展救治。护理要点：护理人员分工、抢救配合护理重点及并发症的预防与处理。历经4 h医院快速反应小组抢救,患者成功止血,脱离危险。术后第13天康复出院。
To summarize the emergency care of a patient with lung cancer undergoing thoracoscopic surgery and complicated with pulmonary arteriovenous rupture and massive hemorrhage,and then undergoing unplanned bilateral thoracotomy. In view of the emergency during the operation and the rapid progress of the disease,the rescue team was immediately set up and the reasonable division of team members was carried out in an orderly manner. The key points of nursing care included division of nursing staff,key nursing points of rescue coordination and the prevention and treatment of complications. The patient was successfully saved from massive haemorrhage after 4 hours of rescue by the rapid response team. On the 13th day after the surgery,the patient recovered and was discharged.
[1] 支修益,石远凯,于金明. 中国原发性肺癌诊疗规范(2015年版)[J]. 中华肿瘤杂志,2015,37(1):67-78.
Zhi XY,Shi YK,Yu JM.Standards for the diagnosis and treatment of primary lung cancer(2015) in China[J]. Chin J Oncol,2015,37(1):67-78.
[2] Ghosh SK,Roy S,Daskiran M,et al.The clinical and economic burden of significant bleeding during lung resection surgery:a retrospective matched cohort analysis of real-world data[J]. J Med Econ,2016,19(11):1081-1086.
[3] 梅建东,蒲强,马林,等. 胸腔镜肺手术中血管损伤出血及其防控策略[J]. 中华外科杂志,2017,55(12):898-902.
Mei JD,Pu Q,Ma L,et al.Strategies for the prevention and control of bleeding due to vascular injury in thoracoscopic lung surgery[J]. Chin J Surg,2017,55(12):898-902.
[4] 刘国辉. 创伤失血性休克液体复苏策略[J]. 中华急诊医学杂志,2018,27(5):473-475.
Liu GH.Application of emergency nursing program in traumatic shock patients[J]. Chin J Emerg Med,2018,27(5):473-475.
[5] Rossaint R,Bouillon B,Cerny V,et al.The European guideline on management of major bleeding and coagulopathy following trauma:fourth edition[J]. Crit Care,2016,20(1):100.
[6] 杨旻斐,王钰炜,詹玥,等. 基于指南的加温输液输血策略对严重创伤伴低体温患者复温效果的研究[J].中华急诊医学杂志,2018,27(5):492-498.
Yang MF,Wang YW,Zhan Y,et al.Effects of heating intravenous fluid infusion and blood transfusion based on guidelines in sever trauma patients with hypothermia[J]. Chin J Emerg Med,2018,27(5):492-498.
[7] 孙亮,高倩,王广,等. 麻醉后恢复室期间全身麻醉患者发生低体温的影响因素[J]. 中华医学杂志,2021,101(1):52-56.
Sun L,Gao Q,Wang G,et al.Risk factors for hypothermia in patients undergoing general anesthesia in the postanesthesia care unit[J]. Natl Med J China,2021,101(1):52-56.
[8] 尹倩,钟梅.再谈产后出血患者出血量的计算[J]. 中华产科急救电子杂志,2015,4(2):98-100.
Yin Q,Zhong M.Talk about the calculation of bleeding volume of postpartum hemorrhage patients again[J]. China J Obstet Emerg(Electronic Edition),2015,4(2):98-100.
[9] 张轲婧. 老年外科手术患者术中低体温的影响因素及其护理[J]. 国际护理学杂志,2021,40(14):2530-2533.
Zhang KJ.Risk factors for hypothermia in patients undergoing general anesthesia in the postanesthesia care unit[J]. Int J Nurs,2021,40(14):2530-2533.
[10] 朱勤春,东莉,杨丽君,等. 3种手术患者压力性损伤评估量表的信效度及预测效果分析[J]. 中华现代护理杂志,2020,26(25):3429-3432.
Zhu QC,Dong L,Yang LJ,et al.Reliability and validity of three kinds of assessment scales on stress injury during surgery and their predictive effects[J]. Chin J Mod Nurs,2020,26(25):3429-3432.
