1例机器人辅助切除巨大肾细胞癌伴Ⅲ级癌栓患者的护理

Perioperative nursing of a patient with massive renal cell carcinoma and Mayo stage Ⅲ tumor thrombus undergoing robot-assisted nephrectomy

总结1例机器人辅助下切除巨大肾细胞癌伴MayoⅢ级癌栓患者术中大出血合并CO_(2)气体栓塞的围手术期护理经验,护理要点如下。术前参与多学科讨论,制订阶梯式术中应急预案;建立一体化护理工作站,优化病情监测。术中加强机器人辅助手术的护理配合;密切监测患者病情,预防术中危重并发症;启动应急预案,积极处理大出血合并CO_(2)气体栓塞;实施结构化体位管理,预防术中坠床风险。术后预防继发性血栓形成及活动性出血;加强肝肾缺血-再灌注损伤的监测与护理。经过多学科救治及精心护理,患者于术后13 d顺利出院。

This research provides an overview of the perioperative nursing care for a patient with a massive renal cell carcinoma and Mayo StageⅢtumor thrombus who underwent a robot-assisted nephrectomy complicated by significant intraoperative bleeding and CO_(2) embolism.Key nursing considerations included multidisciplinary preoperative discussions,developing stepwise intraoperative emergency plans,establishing an integrated nursing workstation,and the optimization of patient monitoring.During the surgery,nursing efforts were focused on supporting the robot-assisted procedure,closely monitoring the patient’s condition,preventing intraoperative complications,initiating emergency plans as needed,actively managing major bleeding and CO_(2) embolism,and implementing structured positioning to minimize the risk of falls during the procedure.Postoperatively,the focus was on preventing secondary thrombus formation,managing active bleeding,and monitoring for liver and kidney ischemia-reperfusion injury.Through multidisciplinary interventions and meticulous nursing care,the patient was discharged after a 13-day postoperative recovery.