1例儿童原发性高草酸尿症合并慢性肾功能不全行肝肾联合移植术术后预防感染的护理

Nursing Care of a Child with Primary Hyperoxaluria Combined with Chronic Renal Insufficiency Undergoing Combined Liver Kidney Transplantation for Infection Prevention

摘要: 本文总结1例儿童原发性高草酸尿症合并慢性肾功能不全(尿毒症期)行肝肾联合移植术术后预防感染的护理。该患儿在气管插管麻醉手术下行同种异体肝肾联合移植术，术后第二天肝动脉血栓形成，当日入放射介入科行移植肝动脉溶栓术，溶栓效果良好，B超检查提示肝动脉显影欠佳，查肝功能进一步恶化，再次入手术室行“剖腹探查 + 肝动脉取栓重建术”。术前充分准备。术中精细操作，避免出血及副损伤。术后下肢制动，避免术口出血，定期检测肝功能、血管彩超等。术后留置有多条管道，经过对症的治疗及有效地护理，采用一系列预防感染的策略，患儿留置的管道均按计划拔除，未发生感染，病情由病危转为普通，最后顺利出院，现定期随访。

Abstract: This paper summarized the nursing care of a child with primary hyper-oxaluria complicated with chronic renal insufficiency (Uremia stage) who underwent combined liver and kidney transplantation to prevent infection. The patient underwent combined liver and kidney transplantation under Tracheal intubation anesthesia. Hepatic artery thrombosis occurred the next day after the operation. On the same day, he was admitted to the radiation intervention department to perform thrombolysis of the transplanted hepatic artery, and the thrombolysis effect was good. Bultrasound examination showed that the hepatic artery was poorly developed, and the liver function further deteriorated. He was again admitted to the operating room for “exploratory laparotomy + hepatic artery thrombectomy and reconstruction”. Adequate preoperative preparation. Fine intra operative operation to avoid bleeding and side injuries. Postoperative lower limb immobilization to avoid bleeding at the surgical site, and regular monitoring of liver function and vascular ultrasound. After the surgery, multiple pipelines were left behind. After targeted treatment and effective care, a series of infection prevention strategies were adopted. The pipelines left behind by the patient were all removed as planned, and no infection occurred. The condition changed from critical to ordinary, and finally, the patient was discharged smoothly. Regular follow-up is now conducted.