1例肝移植术后肺部卡氏肺孢子感染并发颅内出血患儿的护理

doi:10.3761/j.issn.0254-1769.2022.08.016

摘要/Abstract

摘要：

总结1例亲体肝移植术后肺部卡氏肺孢子感染并发颅内出血患儿的护理体会。护理要点包括：早期识别病情变化,提高风险预判能力;控制颅内出血,严密观察肝脏血管并发症的发生;再次启动抗凝治疗,严防二次出血;落实集束化干预措施,预防感染加重;以音乐疗法与叙事护理为基础,采取多种形式的心理护理;制订个体化出院随访计划,建立长期随访方案。经过积极的治疗与护理,患儿病情稳定,顺利出院。随访6个月,患儿情况良好。

关键词: 婴儿, 肝移植术, 肺部感染, 颅内出血, 儿科护理学

Abstract:

This paper summarizes the nursing experience of a child with lung infection complicated with intracranial hemorrhage after the parental liver transplantation. Nursing points：early identification of changes in the condition and improvement of risk prediction ability;treatment of intracranial hemorrhage and closely observing the occurrence of vascular complications;restarting anticoagulation treatment to prevent secondary bleeding;implementing cluster intervention measures to prevent infection worsening;taking various forms of psychological nursing care for children and their families based on music therapy and narrative nursing;developing an individualized discharge follow-up plan to establish a long-term follow-up program. After active treatment and care,the patient was in stable condition and safely discharged. Followed up for 6 months,the child was in fair condition.

Key words: Infant, Liver Transplantation, Pulmonary Infection, Intracranial Hemorrhage, Pediatric Nursing

傅来建, 卢芳燕. 1例肝移植术后肺部卡氏肺孢子感染并发颅内出血患儿的护理[J]. 中华护理杂志, 2022, 57(8): 996-1000.

FU Laijian, LU Fangyan. Nursing care of a child with Pneumocystis Carinii infection and intracranial hemorrhage after liver transplantation[J]. Chinese Journal of Nursing, 2022, 57(8): 996-1000.

参考文献 20

[1]	赵东, 夏强.小儿肝移植的现状与展望[J]. 肝胆外科杂志, 2017, 25(4):244-247.
	Zhao D, Xia Q.Current situation and prospect of pediatric liver transplantation[J]. J Hepatobiliary Surg, 2017, 25(4):244-247.
[2]	Kerkar N, Lakhole A.Pediatric liver transplantation:a North American perspective[J]. Expert Rev Gastroenterol Hepatol, 2016, 10(8):949-959.
[3]	中国研究型医院学会加速康复外科专业委员会.儿童肝移植围手术期管理专家共识[J]. 中华外科杂志, 2021, 59(3):179-191.
	Enhanced Recovery After Surgery Committee of Chinese Research Hospital Association.Expert consensus of perioperative management in pediatric liver transplantation[J]. Chin J Surg, 2021, 59(3):179-191.
[4]	彭宇明, 司中州, 袁妙贤, 等.儿童肝移植20例诊治分析[J]. 临床小儿外科杂志, 2019, 18(8):681-685.
	Peng YM, Si ZZ, Yuan MX, et al. Diagnosis and treatment of hepatic transplantation in 20 children[J]. J Clin Pediatr Surg, 2019, 18(8):681-685.
[5]	邸梦雪, 董环.1例儿童活体肝移植术后并发卡氏肺囊虫肺炎的护理[J]. 实用器官移植电子杂志, 2018, 6(1):57-59.
	Di MX, Dong H.Nursing care of a child with pneumocystis carinii pneumonia after living donor liver transplantation[J]. Pract J Organ Transplant Electron Version, 2018, 6(1):57-59.
[6]	王苑, 蔺建宇, 樊华, 等.肝移植患者术后并发卡氏肺囊虫肺炎行无创正压通气的护理[J]. 护理学报, 2017, 24(16):38-40.
	Wang Y, Lin JY, Fan H, et al. Nursing care of patients with pneumocystis carinii pneumonia after liver transplantation with non-invasive positive pressure ventilation[J]. J Nurs China, 2017, 24(16):38-40.
[7]	马毅, 叶智明, 孙灿辉, 等.原位肝移植术后颅内出血原因和处理[J]. 中国实用外科杂志, 2011, 31(8):703-704.
	Ma Y, Ye ZM, Sun CH, et al. Causes and treatment of intracranial hemorrhage after orthotopic liver transplantation[J]. Chin J Pract Surg, 2011, 31(8):703-704.
[8]	Gallagher TK, Thomas KA, Ladner DP, et al. Incidence and risk factors of intracranial hemorrhage in liver transplant recipients[J]. Transplantation, 2018, 102(3):448-453. DOI PMID
[9]	Gao W, Li J, Nguyen-Buckley C, et al. Intraoperative hypertension and thrombocytopenia associated with intracranial hemorrhage after liver transplantation[J]. Transplantation, 2020, 104(3): 535-541. DOI URL
[10]	刘曌, 马云富, 董辉, 等.婴幼儿颅内出血手术治疗临床分析[J]. 中国实用神经疾病杂志, 2018, 21(8):842-845.
	Liu Z, Ma YF, Dong H, et al. Clinical analysis of surgical treatments of intracranial hemorrhages in infants[J]. Chin J Pract Nerv Dis, 2018, 21(8):842-845.
[11]	谈小云, 齐海锋, 徐南平, 等.床旁超声在儿科急诊中的应用价值[J]. 中国小儿急救医学, 2015, 22(7):502-503.
	Tan XY, Qi HF, Xu NP, et al. Clinical value of bedside-echo-cardiography in pediatric emergency[J]. Chin Pediatr Emerg Med, 2015, 22(7):502-503.
[12]	滕大洪, 吴迪, 张威, 等.再次肝移植危险因素分析的单中心经验总结[J]. 实用器官移植电子杂志, 2019, 7(2):99-102.
	Teng DH, Wu D, Zhang W, et al. Risk factors for liver retransplantation:experience at a single transplantation center[J]. Pract J Organ Transplant Electron Version, 2019, 7(2):99-102.
[13]	陈和安, 刘玖华, 宋文章.单孔钻孔引流术治疗慢性硬膜下血肿临床分析[J]. 中华内分泌外科杂志, 2017, 11(4):339-340.
	Chen HA, Liu JH, Song WZ.Single hole drilling and drainage for 65 chronic subdural hematoma patients[J]. Chin J Endocr Surg, 2017, 11(4):339-340.
[14]	武丹威, 韩爽, 姜璐, 等.片剂分剂量临床现状分析与探讨[J]. 中国医院药学杂志, 2018, 38(21):2281-2285.
	Wu DW, Han S, Jiang L, et al. Analysis and discussion on clinical status of tablet splitting[J]. Chin J Hosp Pharm, 2018, 38(21):2281-2285.
[15]	袁倩倩, 杜雯雯.儿童华法林剂量的影响因素与预测模型研究进展[J]. 儿科药学杂志, 2018, 24(12):60-63.
	Yuan QQ, Du WW.Progress on influencing factors and prediction models of warfarin dose in children[J]. J Pediatr Pha-rm, 2018, 24(12):60-63.
[16]	孙建华, 刘大为, 王小亭, 等.氯己定擦浴对预防ICU患者中心静脉导管相关性血流感染的Meta分析[J]. 中华护理杂志, 2016, 51(2):148-154.
	Sun JH, Liu DW, Wang XT, et al. Chlorhexidine body bathing to prevent central line associated blood stream infections in intensive care units:a systematic review[J]. Chin J Nurs, 2016, 51(2):148-154.
[17]	李静, 苑记清.音乐对机械通气患者焦虑和生理状态影响的Meta分析[J]. 中华护理杂志, 2016, 51(2):235-242.
	Li J, Yuan JQ.The effects of music on anxiety level and phy-siological responses of patients receiving mechanical ventilation:a meta-analysis[J]. Chin J Nurs, 2016, 51(2):235-242.
[18]	黄辉, 刘义兰.叙事护理临床应用的研究进展[J]. 中华护理杂志, 2016, 51(2):196-200.
	Huang H, Liu YL.Research progress on clinical application of narrative nursing[J]. Chin J Nurs, 2016, 51(2):196-200.
[19]	Burns-Nader S, Hernandez-Reif M.Facilitating play for hospitalized children through child life services[J]. Child Heal Care, 2016, 45(1):1-21.
[20]	杨巧玲, 李琳, 黄萍, 等.儿童肝移植随访的现状及展望[J]. 国际护理学杂志, 2020, 39(21):4022-4026.
	Yang QL, Li L, Huang P, et al. Current status and prospect of follow-up for pediatric liver transplantation[J]. Int J Nurs, 2020, 39(21):4022-4026.