移植肾切除术后急性心力衰竭合并呼吸衰竭的多学科综合诊疗

吕广娜; 李宁; 宁媛; 郭文萍

doi:10.3969/j.issn.1674-7445.2021.01.011

移植肾切除术后急性心力衰竭合并呼吸衰竭的多学科综合诊疗

doi: 10.3969/j.issn.1674-7445.2021.01.011

030012 太原，山西省第二人民医院肾移植中心

基金项目:

山西省卫生和计划生育委员会资助项目 2015075

山西省卫生和计划生育委员会资助项目 201601087

详细信息

作者简介:
吕广娜，女，1987年生，硕士，主治医师，研究方向为肾移植围手术期管理，Email:lvguangna.love@163.com

通讯作者:
李宁，女，1972年生，硕士，主任医师，研究方向为肾移植围手术期及长期随访，Email:SXTYLining666@126.com

中图分类号: R617, R54
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出版历程
- 收稿日期: 2020-12-01
- 网络出版日期: 2021-01-19
- 刊出日期: 2021-01-19

Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy

Department of Renal Transplantation, the Second People's Hospital of Shanxi Province, Taiyuan 030012, China

More Information

Corresponding author: Li Ning, E-mail:SXTYLining666@126.com

摘要

摘要: 目的探讨多学科综合诊疗（MDT）在移植肾切除术后急性心力衰竭（AHF）合并呼吸衰竭治疗中的作用。方法对1例突发移植肾出血致失血性休克，行移植肾切除术后2周发生急性心肌梗死（AMI）合并AHF、急性肺淤血、肺部感染、急性呼吸衰竭患者进行MDT讨论，制定治疗方案并进行效果评价。结果综合MDT讨论意见，给予经鼻高流量氧疗、床旁连续性静脉-静脉血液透析滤过（CVVHDF）降低心脏负荷、抗凝、扩张血管、降低心肌耗氧量、改善心肌重塑、调脂、抗感染及营养支持等综合治疗，临床结局良好，患者恢复规律血液透析治疗。结论应用MDT模式可为移植肾切除术后AHF合并呼吸衰竭患者制定全面有效的个体化治疗方案，提高临床治疗效果，改善患者预后。
- 失血性休克 /
- 移植肾切除 /
- 急性心肌梗死（AMI） /
- 急性心力衰竭（AHF） /
- 急性肺淤血 /
- 肺部感染 /
- 急性呼吸衰竭 /
- 多学科综合诊疗（MDT）
Abstract: Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.
- Hemorrhagic shock /
- Allograft nephrectomy /
- Acute myocardial infarction(AMI) /
- Acute heart failure(AHF) /
- Acute pulmonary congestion /
- Pulmonary infection /
- Acute respiratory failure /
- Multi-disciplinary team(MDT)

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图 1 入院时患者胸部CT影像学表现

注：双肺满布片状密度增高影，内、中带明显，“蝶翼征”，纵隔窗病灶区可见实变，胸腔积液。

Figure 1. Imaging findings of chest CT of the patient at admission

下载: 全尺寸图片幻灯片

图 2 入院时患者心电图的动态变化过程

注：A~F图为患者入院当日至入院后3 d心电图，I、aVL、V3~6导联ST段逐渐压低、T波倒置且逐渐加深。

Figure 2. The dynamic change process of electrocardiogram of the patient at admission

下载: 全尺寸图片幻灯片

图 3 治疗后患者胸部CT影像学表现

注：双肺散在密度增高影，纵隔窗病灶区可见实变，少量心包积液，胸腔积液消失。

Figure 3. Imaging findings of chest CT of the patientafter treatment

下载: 全尺寸图片幻灯片

图 4 患者稳定期心电图

注：I、aVL、V3~6导联ST段基本恢复，倒置T波变为正常。

Figure 4. The electrocardiogram of the patientin stable period

下载: 全尺寸图片幻灯片

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