Nursing care of a patient with portal vein thrombosis secondary liver failure after liver transplantation

doi:10.3761/j.issn.0254-1769.2020.12.017

Abstract

Abstract:

To summarize the nursing process of a patient with portal vein thrombosis secondary liver failure after liver transplantation who underwent a liver re-transplantation. Nursing points：Based on collaboration of multi-disciplinary teams,during the process of artificial liver support treatment,the accuracy of the dosage of anticoagulant drugs was ensured;coagulation indicators were observed closely,and bleeding prevention measures were implemented. The measures to prevent thrombosis during the perioperative period of re-transplantation were taken and liver blood flow changes were dynamically monitored. During the implementation of minimal immunosuppressive therapy,acute rejection and infection were strictly prevented;during the concurrent chylofistula,a low-fat diet and drainage tube care were carried out. The patient was discharged on foot on the 63rd day after admission.

Key words: Liver Transplantation, Portal Vein, Thromboembolism, Liver Failure, Nursing Care

摘要：

总结1例肝移植术后门静脉血栓形成继发移植肝衰竭患者行再次肝移植的护理过程。护理要点：依托多学科合作,人工肝支持治疗过程中确保抗凝药物剂量精准、密切观察凝血指标、落实出血防范措施;再次肝移植围手术期做好血栓预防措施、动态监测肝脏血流变化;实施最小免疫抑制治疗期间,严密防范急性排斥反应和感染;并发乳糜瘘期间做好低脂饮食和引流管护理。患者于入院后第63天步行出院。

关键词: 肝移植, 门静脉, 血栓栓塞, 肝功能衰竭, 护理

SHEN Mingyan,LU Jianfang,JIN Yaxian,ZHANG Yuanyuan,CHEN Xiang,FENG Zhixian. Nursing care of a patient with portal vein thrombosis secondary liver failure after liver transplantation[J]. Chinese Journal of Nursing, 2020, 55(12): 1855-1858.

沈鸣雁,鲁剑芳,金亚仙,张园园,陈翔,冯志仙. 1例肝移植术后门静脉血栓形成继发肝衰竭患者的护理[J]. 中华护理杂志, 2020, 55(12): 1855-1858.

References 18

[1]	Forner A, Reig M, Bruix J. Hepatocellular carcinoma[J]. Lancet, 2018,391(10127):1301-1314. DOI URL PMID
[2]	Hibi T, Nishida S, Levi DM, et al. When and why portal vein thrombosis matters in liver transplantation:a critical audit of 174 cases[J]. Ann Surg, 2014,259(4):760-766.
[3]	Kensinger CD, Sexton KW, Baron CM, et al. Management of portal vein thrombosis after liver transplantation with a combined open and endovascular approach[J]. Liver Transpl, 2015,21(1):132-134. URL PMID
[4]	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 re-transplantation:experience at a single transplantation center[J]. Prac J Organ Transplant(Electronic Version), 2019,7(2):99-102.
[5]	中华医学会器官移植学分会. 中国肝移植术操作规范(2019版)[J]. 中华移植杂志(电子版), 2019,13(3):171-176.
	Chinese Society of Organ Transplantation,Chinese Medical Association. Operation standards for liver transplantation in China(version 2019)[J]. Chin J Transplant(Electronic Edition), 2019,13(3):171-176.
[6]	金磊, 殷浩, 傅宏, 等. 再次肝移植38例经验[J]. 中华普通外科杂志, 2015,30(7):532-534.
	Jin L, Yin H, Fu H, et al. Experiences of liver retransplantation in 38 cases[J]. Chin J Gen Surg, 2015,30(7):532-534.
[7]	滕飞, 傅志仁. 肝移植中基于门静脉重建方案的门静脉血栓分类及处理策略[J]. 器官移植, 2018,9(4):245-249.
	Teng F, Fu ZR. Classification and treatment strategies of portal vein thrombosis based on portal vein reconstruction scheme in liver transplantation[J] Organ Transplant, 2018,9(4):245-249.
[8]	中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016版)[J]. 中华临床感染病杂志, 2016,9(2):97-103.
	Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association. Guideline for non-bioartificial liver support systems in treatment of liver failure:2016 update[J]. Chin J Clin Infect Dis, 2016,9(2):97-103.
[9]	李兰娟. 人工肝脏[M]. 杭州: 浙江大学出版社, 2012: 422-426.
	Li LJ. Artificial liver[M]. Hangzhou: Zhejiang University Press, 2012: 422-426.
[10]	邹鹏飞, 屠明敏, 戴霞红, 等. 小剂量阿加曲班与低分子肝素在李氏人工肝治疗中抗凝疗效及安全性比较[J]. 中华临床感染病杂志, 2019(3):201-205.
	Zou PF, Tu MM, Dai XH, et al. Comparison of anticoagulation efficacy and safety between small dose argatroban and low molecular weight heparin applied in Li’s artificial liver support system[J]. Chin J Clin Infect Dis, 2019(3):201-205.
[11]	张婧婧, 俞萍, 任国琴. 标准化沟通模式在急诊科安全管理中的应用[J]. 中华现代护理杂志, 2017,23(27):3450-3453.
	Zhang JJ, Yu P, Ren GQ. Application of SBAR communication mode on safety management in emergency department[J]. Chin J Mod Nurs, 2017,23(27):3450-3453.
[12]	崔恒, 傅巧美, 周利平, 等. 终末期肝病患者接受反位肝脏供体移植手术的护理[J]. 中华护理杂志, 2019,54(11):1718-1721.
	Cui H, Fu QM, Zhou LP, et al. Nursing experience of a liver transplantation patient using a liver from a situs inversus donor after heart death[J]. Chin J Nurs, 2019,54(11):1718-1721.
[13]	Couri T, Harmath C, Baker T, et al. Acute portal vein thrombosis after liver transplant presenting with subtle ultrasound abnormalities:a case report and literature review[J]. World J Hepatol, 2019,11(2):234-241.
[14]	李萌, 郭学利, 刘聪, 等. 孤立性小腿深静脉血栓形成的临床分析[J]. 中华普通外科杂志, 2017,32(5):393-396.
	Li M, Guo XL, Liu C, et al. Isolated calf deep vein thrombosis[J]. Chin J Gen Surg, 2017,32(5):393-396.
[15]	赵红川, 耿小平. 再次肝移植临床进展[J]. 肝胆外科杂志, 2016,24(6):404-406.
	Zhao HC, Geng XP. Clinical progress of liver transplantation again[J]. J Hepatobiliary Surg, 2016,24(6):404-406.
[16]	孙晓叶, 沈中阳. 再次肝移植术后免疫抑制剂的应用分析[J]. 实用器官移植电子杂志, 2019,7(2):95-98.
	Sun XY, Shen ZY. Application analysis of immunosuppressive agents after liver retransplantation[J]. Prac J Organ Transplant(Electronic Version), 2019,7(2):95-98.
[17]	沈鸣雁, 李清. 1例多发性内分泌肿瘤伴抑郁症患者的护理[J]. 中华护理杂志, 2016,51(4):502-505.
	Shen MY, Li Q. Nursing care of a patient with multiple endocrine neoplasia and depression[J]. Chin J Nurs, 2016,51(4):502-505.
[18]	赵会玲, 冯先琼, 余蓉, 等. 病人出院准备度护理研究进展[J]. 中国护理管理, 2013,13(6):81-83.
	Zhao HL, Feng XQ, Yu R, et al. Nursing of readiness for hospital discharge:a systematic review of the literature[J]. Chin Nurs Manag, 2013,13(6):81-83.