老年肝移植患者的人工耳蜗植入病例报告和文献复习

A Case Report and Literature Review:Cochlear Implantation in an Older Liver Transplant Recipient

目的探讨肝移植术后植入人工耳蜗的感音神经性耳聋老年患者临床处治特点和注意事项。方法肝移植术后老年患者1例,62岁女性,双耳感音神经性耳聋(全聋)超过10年,肝移植术后长期服用抗排异、激素药物,移植后8年行人工耳蜗植入术。针对患者的特殊病史和身体条件,人工耳蜗植入术后除进行常规开机外,给予肝功能保护、监测他克莫司浓度、感染、心理护理等处治措施。结果肝移植老年患者开机1年8个月后助听听阈≤35 dB HL,单音节识别率70.67%,双音节识别率85%,言语空间音质听力量表(the speech,spatial and qualities of hearing scale,SSQ)得分19分。未见与肝移植相关并发症,术后心理状态明显改善,生活质量显著提高。结论人工耳蜗植入术对肝移植后接受免疫抑制治疗的老年患者是一种安全有效的干预手段。突出抗感染、提升免疫力对确保手术安全性、有效性至关重要。

Objective To investigate the characteristics and precautions of postoperative nursing for elderly patient of cochlear implantation with sensorineural hearing loss after liver transplantation.Methods A 62-year-old female with sensorineural hearing loss in both ears(total deafness according to WHO 2021 classification criteria)for more than 10 years after liver transplantation.Anti-rejection and hormone have been used for a long time after liver transplantation,and cochlear implantation was implemented 8 years after liver transplantation.According to the patient's special medical history and physical conditions,systematic management was given after cochlear implantation,including postoperative observation of the operative area,liver function protection,postoperative psychological nursing and discharge guidance,and other measures,to evaluate the patient's hearing and psychological state.Results Through reasonable treatment and post operation care,the hearing of the patient was restored after cochlear implantation.The psychological state and the quality of life were significantly improved.No complication related to liver transplantation was observed.Conclusions A cochlear implant is a safe and effective intervention for elderly patients receiving immunosuppressive therapy after liver transplantation.In view of the special requirements of the safety of cochlear implantation for liver transplant patients,comprehensive professional and meticulous nursing should be carried out to highlight anti-infection and enhance immunity.