吕广娜, 李宁, 宁媛, 等. 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[J]. 器官移植, 2021, 12(1): 70-76. DOI: 10.3969/j.issn.1674-7445.2021.01.011
引用本文: 吕广娜, 李宁, 宁媛, 等. 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[J]. 器官移植, 2021, 12(1): 70-76. DOI: 10.3969/j.issn.1674-7445.2021.01.011
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Lyu Guangna, Li Ning, Ning Yuan, et al. Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy[J]. ORGAN TRANSPLANTATION, 2021, 12(1): 70-76. DOI: 10.3969/j.issn.1674-7445.2021.01.011
Citation: Lyu Guangna, Li Ning, Ning Yuan, et al. Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy[J]. ORGAN TRANSPLANTATION, 2021, 12(1): 70-76. DOI: 10.3969/j.issn.1674-7445.2021.01.011
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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

    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。

     

    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.

     

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