Staged capacity management and nursing practice of viral encephalitis and acute multiple cerebral infarction in 1 case of peritoneal dialysis
1例腹膜透析患者并发病毒性脑炎及急性多性脑梗死的阶段性容量管理及护理实践

摘要

本文总结了1例腹膜透析（PD）患者并发病毒性脑炎及急性多发性脑梗死的护理实践。患者病情复杂危重，临床表现包括高热、意识障碍及神经功能缺损，诊治难度较大。护理过程中，早期依托多学科团队（MDT）协作，及时完成病原学检测与影像学评估，并在急性期通过严格监测生命体征、预警机制和精准执行医嘱，确保患者病情稳定。脑梗阶段重点采取自动化腹膜透析机（APD）联合艾考糊精透析液的分阶段容量管理，既维持体液平衡，又最大限度保护残余肾功能，降低并发感染和电解质紊乱风险。恢复期联合营养科和康复科，实施个体化营养支持与早期功能训练，同时通过建立随访体系和强化家庭护理培训，保证患者长期依从性。经综合护理干预，患者神志恢复，肢体肌力明显改善，无严重后遗症，生活能够自理，营养状态良好，目前在门诊规律随访。本案例提示，对PD患者合并神经系统急危重症时，应重视MDT协作、分阶段容量管理和个体化综合护理，以改善预后并提升生活质量。

Abstract

This article summarizes the nursing practice of a peritoneal dialysis (PD) patient with concurrent viral encephalitis and acute multiple cerebral infarctions. The patient presented with a complex and critical condition, exhibiting clinical manifestations including high fever, impaired consciousness, and neurological deficits, presenting significant diagnostic and therapeutic challenges. During the initial phase, multidisciplinary team (MDT) collaboration was implemented to promptly complete pathogen detection and imaging assessments. Throughout the acute phase, strict vital sign monitoring, early warning mechanisms, and precise adherence to medical protocols ensured patient stability. During the cerebral infarction phase, staged volume management using automated peritoneal dialysis (APD) combined with acetyl dextran dialysate was prioritized to maintain fluid balance while maximizing residual renal function and reducing risks of infection and electrolyte imbalances. In the recovery phase, integrated nutrition and rehabilitation support were provided through collaboration with nutrition and rehabilitation departments, complemented by long-term follow-up systems and enhanced home care training to ensure sustained patient compliance. Comprehensive nursing interventions led to complete consciousness restoration, marked improvement in limb muscle strength, absence of severe sequelae, self-sufficiency in daily activities, and good nutritional status, with the patient currently undergoing regular outpatient follow-ups. This case highlights the importance of MDT collaboration, staged volume management, and personalized comprehensive nursing care for PD patients with neurological emergencies to improve prognosis and quality of life.