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