路 梅,陈秀华,罗怀稳,王 艳,吴艳菊

本文报道了一例28岁女性患者，因腹痛入院，最终诊断为膈下异位妊娠破裂出血合并失血性休克。患者病情危重，急诊行腹腔镜探查止血术，术后转入重症医学科。护理团队在此过程中提供了全面、精细的围手术期护理，包括急诊的抗休克和病情监测、术前准备和心理支持、术中的配合与保暖，以及术后重症监护下的基础护理、气道管理、伤口护理、康复指导、饮食护理和心理支持。本案例强调了在罕见部位异位妊娠破裂导致失血性休克危重患者救治中，护理工作在生命体征监测、病情评估、紧急处理配合、并发症预防及身心支持方面的重要作用。

失血性休克；膈下异位妊娠；失血性休克；急诊护理

[1] Shetty JP,Shetty B,Makkanavar JH,Chandrika.A rare case of bilateral tubal pregnancy.J Indian Med Assoc.2011;109(7):506-7. [2] Son SY,Wu E,Gariwala V,O'Neill C.Mesenteric ectopic pregnancy with tubo-ovarian abscess.Radiol Case Rep.2021;16(5):1165-1168. [3] Zheng X,Zhou Y,Sun Z,Yan T,Yang Y,Wang R.Abdominal pregnancy secondary to uterine horn pregnancy:a case report.BMC Pregnancy Childbirth.2023;23(1):412. [4] Kuo K,Palmer L.Pathophysiology of hemorrhagic shock.J Vet Emerg Crit Care(San Antonio).2022;32(S1):22-31. [5] Clendenen N,Nunns GR,Moore EE,et al.Hemorrhagic shock and tissue injury drive distinct plasma metabolome derangements in swine.J Trauma Acute Care Surg.2017;83(4):635-642. [6] 131例异位妊娠急诊手术护理[C]//2006全国急危重病护理(珠海)学术研讨会论文集.2006:107-108. [7] Kuo K,Palmer L.Pathophysiology of hemorrhagic shock.J Vet Emerg Crit Care(San Antonio).2022;32(S1):22-31. [8] AlZahrani R,Al Thobaity A,Saleh MSM.Identifying the obstacles facing emergency nurses regarding treating CTAS1 and CTAS2 in Saudi Arabia.BMC Emerg Med.2024;24(1):123. [9] 李丽芳,吴兰娟.手术护理流程优化对异位妊娠患者抢救效果及预后的影响研究[J].基层医学论坛,2023,27(21):4-6. [10] Xie D,Zhu X,Zhang X,Jiang Z,Liu T.The impact of support from emergency nurse organizations on compassion fatigue:the mediating role of psychological capital.Front Public Health.13:1551381. [11] Al-Abdallah AM,Malak MZ.Factors correlating with prolonged fatigue among emergency department nurses.J Res Nurs.2019;24(8):571-584. [12] Gillespie GL,Berry P.Qualitative Analysis of Workplace Assault Outcomes from the Perspectives of Emergency Nurses.J Emerg Nurs. 2023;49(3):450-460. [13] Jovanovic T,Nylocks KM,Gamwell KL,et al.Development of fear acquisition and extinction in children:effects of age and anxiety. Neurobiol Learn Mem.113:135-42. [14] 邬丹萍.心理护理在异位妊娠急诊护理的应用探讨[J].中外女性健康研究,2020(11):162,192. [15] Dyer KFW,Shannon C,McCann L,et al.Psychological support for healthcare workers during the COVID-19 pandemic:a mixed methods study involving support providers.Eur J Psychotraumatol.2022;13(2):2151282. [16] Egan P,Pierce A,Flynn A,Teeling SP,Ward M,McNamara M.Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time:A Lean Six Sigma Pilot Study.Int J Environ Res Public Health.2021;18(22).Published 2021 Nov 18. [17] Dyas AR,Lovell KM,Balentine CJ,et al.Reducing cost and improving operating room efficiency:examination of surgical instrument processing.J Surg Res.229:15-19.

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