合并严重新型冠状病毒感染移植肾失功患者行急诊移植肾切除术的麻醉管理1例

Anesthesia management in patient with renal allograft dysfunction after severe SARS‑CoV‑2 infection undergoing emergen‑cy transplantation nephrectomy:a case report

多器官功能不全患者接受外科手术时,围手术期麻醉管理面临重大挑战。全面的术前评估及术中麻醉管理对于提高麻醉手术安全性和术后康复具有重要意义。此例患者在肾移植手术后发生危重型新型冠状病毒感染,接连出现移植肾失功、心功能不全、肺动脉高压、呼吸衰竭、脓毒症、肾性贫血,术中通过循环管理、心功能支持、容量管理、保护性通气策略以及抗炎和抗应激、保温等综合处理,患者顺利平稳完成手术。

Perioperative anesthesia management in patients with multiple organ dysfunction is challenging for anesthesiolo‑gists.Preoperative evaluation and preparation as well as intraoperative anesthesia management are of great significance for improving the safety of surgery and postoperative recovery.This patient suffered from severe infection with severe acute respiratory SARS‑CoV‑2,which resulted in renal allograft dysfunction.Before surgery,the patient presented cardiac insufficiency,severe mitral insufficiency,pulmonary hypertension,respiratory failure,renal insufficiency,sepsis and renal anemia.Through comprehensive management,includ‑ing circulation management,cardiac function support,volume management,protective ventilation strategy,anti‑inflammatory and anti‑stress treatment and heat preservation,the patient successfully completed the surgery.