总结1例儿童急性肝衰竭复发患儿的护理体会。针对患儿急性肝功能丧失、极高病死率、缺乏循证护理方案等问题,采取紧急启动治疗性血浆置换+连续性肾脏替代疗法组合进行体外肝脏辅助、选择局部枸橼酸抗凝方案。经过32 d救治和护理,患儿未行肝移植的情况下,治愈出院。
To summarize the nursing experience of a child with recurrent acute liver failure. In order to solve the problems of acute liver function loss,extremely high mortality and lack of evidence-based nursing scheme,the combination of emergency therapeutic plasma exchange and continuous renal replacement therapy was adopted for extracorporeal liver-assist,and regional citrate anticoagulation scheme was selected. After 32 days of treatment and nursing,he was cured and discharged without liver transplantation.
[1] Squires JE,Alonso EM,Ibrahim SH,et al.North American society for pediatric gastroenterology,hepatology,and nutrition position paper on the diagnosis and management of pediatric acute liver failure[J]. J Pediatr Gastroenterol Nutr,2022,74(1):138-158.
[2] Walabh P,Meyer A,de Maayer T,et al. Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure[J]. BMC Pediatr,2022,22(1):516.
[3] Zoica BS,Deep A.Extracorporeal renal and liver support in pediatric acute liver failure[J]. Pediatr Nephrol,2021,36(5):1119-1128.
[4] 扈芳,白科,刘成军. 局部枸橼酸抗凝在肝衰竭儿童连续肾脏替代治疗中的临床应用[J]. 中国小儿急救医学,2021,28(4):333-336.
Hu F,Bai K,Liu CJ.Clinical application of regional citrate anticoagulation for continuous renal replacement therapy in children with liver failure[J]. Chin Pediatr Emerg Med,2021,28(4):333-336.
[5] 夏姗姗,陈晓飞,丁亚平,等. 迟发型鸟氨酸氨甲酰转移酶缺乏症并发肝性脑病急性期患儿的护理[J]. 中华急危重症护理杂志,2023,4(4):334-337.
Xia SS,Chen XF,Ding YP,et al.Nursing care of a child with acute hepatic encephalopathy caused by late-onset ornithine carbamoyltransferase deficiency[J]. Chin J Emerg Crit Care Nurs,2023,4(4):334-337.
[6] Daverio M,Cortina G,Jones A,et al.Continuous kidney replacement therapy practices in pediatric intensive care units across Europe[J]. JAMA Netw Open,2022,5(12):e2246901.
