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  

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

作　　者：吕广娜 李宁 宁媛 郭文萍 Lyu Guangna;Li Ning;Ning Yuan;Guo Wenping(Department of Renal Transplantation,the Second People's Hospital of Shanxi Province,Taiyuan 030012,China)

机构地区：[1]山西省第二人民医院肾移植中心,太原030012

出　　处：《器官移植》2021年第1期70-76,共7页Organ Transplantation

基　　金：山西省卫生和计划生育委员会资助项目(2015075、201601087)。

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。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.

关 键 词：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) 

分 类 号：R617[医药卫生—外科学] R54[医药卫生—临床医学]