1例肾移植术后合并急性抗体介导排斥反应患者的护理

doi:10.3761/j.issn.0254-1769.2023.10.011

中华护理杂志 ›› 2023, Vol. 58 ›› Issue (10): 1225-1229.DOI: 10.3761/j.issn.0254-1769.2023.10.011

1例肾移植术后合并急性抗体介导排斥反应患者的护理

马铮铮(), 钮美娥(), 钱春娅, 吴丽芬, 王丽丽, 周政

215031 苏州市苏州大学附属第一医院泌尿外科（马铮铮，钱春娅，吴丽芬，王丽丽，周政），护理部（钮美娥）

收稿日期:2022-11-02 出版日期:2023-05-20 发布日期:2023-05-30
通讯作者: 钮美娥，E-mail：meniu@suda.edu.cn
作者简介:马铮铮：女，硕士，主管护师，E-mail：13776042010@163.com
基金资助:
苏州市科技计划项目(SKJY2021065);苏州大学附属第一医院“周氏”护理科研项目(HLKY-Z-202102)

Nursing of a patient combined with acute antibody-mediated rejection after kidney transplantation

MA Zhengzheng(), NIU Mei’e(), QIAN Chunya, WU Lifen, WANG Lili, ZHOU Zheng

Received:2022-11-02 Online:2023-05-20 Published:2023-05-30

摘要/Abstract

摘要：

总结1例肾移植术后合并急性抗体介导排斥反应患者的护理经验。护理要点：及早识别消化道出血，积极预防低血容量性休克；严密观察输血并发症；预防深静脉血栓及颈内静脉血栓；提供分阶段营养支持，维持内环境稳定；及早识别急性抗体介导排斥反应，启动应急预案；血浆置换的管理；免疫抑制药物精准化护理；全程心理疏导，缓解患者负性情绪。经过81 d积极治疗与精心护理，患者康复出院。

关键词: 肾移植, 上消化道出血, 急性抗体介导排斥反应, 护理

Abstract:

To summarize the nursing experience of a patient with recurrent upper gastrointestinal bleeding combined with acute antibody-mediated rejection after kidney transplantation. Nursing points：early identification of upper gastrointestinal bleeding，active prevention of hypovolemic shock；close observation of complications after blood transfusion；prevention of deep vein thrombosis and internal jugular vein thrombosis；providing staged nutritional support to maintain the stability of internal environment；early identification of acute antibody-mediated rejection and initiation of emergency plan；management of plasma exchange；precision nursing of immunosuppressive drugs；the whole process of psychological counseling was given to relieve the negative emotions of patients. After 81 days of active treatment and intensive care，the patient recovered and was discharged from the hospital.

Key words: Kidney Transplantation, Upper Gastrointestinal Hemorrhage, Acute Antibody-Mediated Rejection, Nursing Care

马铮铮, 钮美娥, 钱春娅, 吴丽芬, 王丽丽, 周政. 1例肾移植术后合并急性抗体介导排斥反应患者的护理[J]. 中华护理杂志, 2023, 58(10): 1225-1229.

MA Zhengzheng, NIU Mei’e, QIAN Chunya, WU Lifen, WANG Lili, ZHOU Zheng. Nursing of a patient combined with acute antibody-mediated rejection after kidney transplantation[J]. Chinese Journal of Nursing, 2023, 58(10): 1225-1229.

参考文献 15

[1]	刘志佳, 石炳毅. 中华医学会2019年器官移植学年会纪要[J]. 中华移植杂志(电子版), 2020, 14(1):62-63.
	Liu ZJ, Shi BY. Summary of the 2019 annual meeting of Chinese Medical Association of Organ Transplantation[J]. Chin J Transplant(Electronic Edition), 2020, 14(1):62-63.
[2]	Ma ZZ, Yang HJ, Pan X, et al. Construction of a nursing solution to prevent and control urinary tract infection in the early stages of kidney transplantation[J]. Transl Androl Urol, 2021, 10(12):4392-4401. DOI URL
[3]	Heo Y, Park HS, Shin CS, et al. Successful treatment of life-threatening small bowel bleeding with thalidomide after living donor kidney transplantation:a case report[J]. Transplant Proc, 2019, 51(9):3092-3098. DOI URL
[4]	刘慧芳, 王孟春. 小肠出血167例病因探讨[J]. 中华消化杂志, 2020, 40(1):50-52.
	Liu HF, Wang MC. Etiological study of 167 cases of small intestinal hemorrhage[J]. Chin J Dig, 2020, 40(1):50-52.
[5]	崔瑜, 张雷, 吴建永. 肾移植抗体介导排斥反应的预防及诊疗要点[J]. 中华医学杂志, 2022, 102(26):2041-2044.
	Cui Y, Zhang L, Wu JY. A study on the prevention,diagnosis and treatment of antibody-mediated rejection in renal transplantation[J]. Natl Med J Chin, 2022, 102(26):2041-2044.
[6]	Bradbury CA, Pell J, Hill Q, et al. Mycophenolate mofetil for first-line treatment of immune thrombocytopenia[J]. N Engl J Med, 2021, 385(10):885-895. DOI URL
[7]	Ueta H, Kitazawa Y, Sawanobori Y, et al. Single blood transfusion induces the production of donor-specific alloantibodies and regulatory T cells mainly in the spleen[J]. Int Immunol, 2018, 30(2):53-67. DOI PMID
[8]	徐维维, 程雪梅, 黄格, 等. 肾移植患者术中输血的危险因素分析[J]. 国际麻醉学与复苏杂志, 2022, 43(7):707-711.
	Xu WW, Cheng XM, Huang G, et al. Risk factor analysis of intraoperative blood transfusion in patients with renal transplantation[J]. Int J Anesth Resus, 2022, 43(7):707-711.
[9]	Kitano D, Yonezawa K, Iwae S, et al. Internal jugular vein thrombosis and pulmonary thromboembolism after head and neck reconstructive surgery[J]. J Plast Reconstr Aesthet Surg, 2021, 74(6):1239-1245. DOI PMID
[10]	许彩云, 孙红玲, 夏金萍, 等. 1例直肠癌患者术后继发腹壁多处坏死性软组织感染的护理[J]. 中华护理杂志, 2022, 57(18):2247-2251.
	Xu CY, Sun HL, Xia JP, et al. Nursing care of a rectal cancer patient with secondary to multiple necrotizing soft tissue infection in abdominal wall[J]. Chin J Nurs, 2022, 57(18):2247-2251.
[11]	丁亚平, 周红琴, 夏姗姗, 等. 肠型白塞病患儿消化道出血及穿孔的护理[J]. 中华护理杂志, 2021, 56(3):435-438. DOI URL
	Ding YP, Zhou HQ, Xia SS, et al. Nursing care of a child with intestinal Behcet’s disease complicated with gastrointestinal bleeding and perforation[J]. Chin J Nurs, 2021, 56(3):435-438.
[12]	朱晓隆, 张晓伟, 隋明星, 等. 肾移植后新生DSA针对性位点初步观察和新生DQ DSA产生的相关因素分析[J]. 中华器官移植杂志, 2020, 41(12):717-720.
	Zhu XL, Zhang XW, Sui MX, et al. Preliminary study of HLA antigens directed against by de novo DSA and correlation factors of DQ DSA generation after kidney transplantation[J]. Chin J Organ Transplant, 2020, 41(12):717-720.
[13]	Hariharan S, Israni AK, Danovitch G. Long-term survival after kidney transplantation[J]. N Engl J Med, 2021, 385(8):729-743. DOI URL
[14]	林燕, 俞超, 高春华, 等. 1例肾移植术后患者合并应激性心肌病的急救与护理[J]. 中华护理杂志, 2022, 57(18):2252-2256.
	Lin Y, Yu C, Gao CH, et al. First aid and nursing care of a patient with induced stress cardiomyopathy after kidney transplantation[J]. Chin J Nurs, 2022, 57(18):2252-2256.
[15]	张荣梅, 杨蓓. 肾移植术后患者焦虑、抑郁及疲乏对其健康影响的纵向研究[J]. 中华护理杂志, 2019, 54(12):1771-1776. DOI URL
	Zhang RM, Yang B. A longitudinal study of anxiety,depression,fatigue,and their impact on health status in renal transplant recipients[J]. Chin J Nurs, 2019, 54(12):1771-1776. DOI URL

1例肾移植术后合并急性抗体介导排斥反应患者的护理

Nursing of a patient combined with acute antibody-mediated rejection after kidney transplantation

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 15

相关文章 15

编辑推荐

Metrics

[1]	韩冬芳, 田甜, 高畅, 张婧珺, 李小妹. 肺结核患者健康促进行为与健康心理控制源关系的混合研究[J]. 中华护理杂志, 2024, 59(9): 1029-1036.
[2]	司茜茜, 王莹, 赵福云, 马晓骁, 刘均娥. A型主动脉夹层患者Ⅰ期心肺康复护理方案的构建及应用[J]. 中华护理杂志, 2024, 59(9): 1037-1042.
[3]	沈支佳, 陈新宇, 钱志杰, 殷丽梅. 反复低血糖患者血糖管理行为退化特征的混合研究[J]. 中华护理杂志, 2024, 59(9): 1043-1050.
[4]	王丽梅, 李露, 李玉霞, 喻鹏, 罗倩, 张翀旎. 糖尿病周围神经病理性疼痛患者运动恐惧现状及影响因素分析[J]. 中华护理杂志, 2024, 59(9): 1051-1056.
[5]	丁慧敏, 戴莉敏, 蔡冬青, 杨群. 糖尿病前期患者自我管理潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1057-1064.
[6]	刘海婷, 王咏梅, 郑贝贝, 蔡丽丽, 叶林斌, 吴佳芸, 宁丽, 李益民, 陈为霞. 冠心病合并糖尿病患者药物素养自评量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1065-1071.
[7]	陈丽霞, 施慧, 朱德政, 曾莹. 成人低血糖恐惧评估工具的质量评价[J]. 中华护理杂志, 2024, 59(9): 1072-1079.
[8]	中国研究型医院学会过敏医学专业委员会, 中华医学会变态反应分会过敏性疾病护理学组（筹）, 中华预防医学会过敏病预防与控制专业委员会, （执笔：王青刘君支凡万文锦田丰英霍晓鹏周文华杨永仕王田田孙劲旅）. 变应原特异性免疫治疗皮下注射护理的专家共识[J]. 中华护理杂志, 2024, 59(9): 1080-1083.
[9]	李琪, 苏晴晴, 张瑶瑶, 王田田, 吕静, 李亚可, 李海燕. 全膝关节置换患者关节遗忘变化轨迹及影响因素研究[J]. 中华护理杂志, 2024, 59(9): 1084-1090.
[10]	刘娅, 刘晓晴, 杨雪凝, 王平, 刘学奎, 罗丹. 结肠镜检查患者肠道准备失败风险预测模型的构建及验证[J]. 中华护理杂志, 2024, 59(9): 1091-1098.
[11]	孙晓晴, 张爱霞, 朱珠, 樊雪梅, 梅士娟, 黄欣欣, 丛胜楠, 谢红燕. 分娩心理创伤评估量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1099-1105.
[12]	谢玉生, 黄蓉蓉, 赵雪, 马蕾, 胡雁, 杨倩, 王乾沙, 明玥. 成人重度烧伤患者肠内肠外营养的证据总结[J]. 中华护理杂志, 2024, 59(9): 1106-1113.
[13]	李旭琴, 冯洁惠, 黄昉芳, 俞超, 梁诗雨, 王晓, 李旭芳, 朱含. 1例行机械循环辅助桥接心脏移植患者的术前护理[J]. 中华护理杂志, 2024, 59(9): 1114-1117.
[14]	贾晓静, 陈一竹, 许志英, 和霞, 耿超. 1例尿黑酸尿症双膝关节置换术后患者并发急性心肌梗死的护理[J]. 中华护理杂志, 2024, 59(9): 1118-1121.
[15]	顾培培, 曾妃, 兰美娟, 梁江淑渊, 郭璐瑶, 蔡凌云, 朱岩, 郭鸽. 肺移植患者衰弱影响因素的Meta分析[J]. 中华护理杂志, 2024, 59(9): 1122-1129.