Nursing care of patients with severe autoimmune encephalitis complicated with teratoma after surgery of immunoadsorption
重症自身免疫性脑炎合并畸胎瘤术后免疫吸附患者的护理

摘要

目的 总结1例重症抗N‑甲基‑D‑天冬氨酸受体（NMDAR）脑炎，合并卵巢畸胎瘤，肿瘤切除后实施蛋白A免疫吸附治疗患者的整体护理实践。方法 对该例患者开展多学科协同照护，落实腹腔镜畸胎瘤切除围手术期护理、神经重症气道管理、多重耐药菌感染防控、蛋白A免疫吸附专项护理，密切监测生命体征与神经系统症状变化，做好并发症预警干预。结果 经手术切除病灶、药物联合免疫吸附治疗及系统化护理干预，患者神经功能逐步恢复，认知、运动能力改善，顺利出院。结论 针对畸胎瘤相关重症抗NMDAR脑炎，除规范开展病因治疗外，围手术期气道保护、血液净化专项护理、多重耐药菌管控是改善患者预后的关键，可为同类病例护理提供参考。

Abstract

Objective This paper summarizes the overall nursing practice of a patient with severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, complicated with ovarian teratoma, after tumor resection and implementation of protein A immunoadsorption treatment.
Methods A multidisciplinary collaborative care was carried out for this patient, and perioperative care for laparoscopic teratoma resection, neurocritical airway management, prevention and control of multidrug-resistant bacterial infections, specialized nursing for protein A immunoadsorption were implemented. Close monitoring of vital signs and changes in neurological symptoms was conducted, and warning and intervention for complications were carried out.
Results After surgical resection of the lesion, combined drug and immunoadsorption treatment, and systematic nursing intervention, the patient’s neurological function gradually recovered, cognition and motor ability improved, and was discharged smoothly.
Conclusion   For patients with severe anti-NMDAR encephalitis related to teratoma, in addition to standard etiological treatment, perioperative airway protection, specialized nursing for blood purification, and control of multidrug-resistant bacteria are the key to improving the prognosis, which can provide a reference for the nursing of similar cases.