体外膜肺氧合技术治疗28例严重呼吸、循环衰竭患者的护理

NURSING CARE OF EXTRACORPORAL MEMBRANE OXYGENATION IN THE INTENSIVE CARE UNIT

目的总结体外膜肺氧合(Extracorporeal Memberane Oxygenation,ECMO)的护理经验。方法对28例严重呼吸、循环衰竭患者采用颈内静脉股静脉插管建立体外膜肺氧合(V-VECMO)或股静脉股动脉插管建立体外膜肺氧合(V-AECMO)进行ECMO技术救治;护理上注意监测血气、血液动力学、活化凝血时间等指标,观察和调整血流速、呼吸机参数,做好氧合器及管道的管理,同时加强原发病护理、积极预防并发症发生。结果 28例患者均能于辅助治疗后停机拔除动、静脉插管。停机后继续机械通气治疗和肺外器官功能支持治疗。6例分别于ECMO停机后4、5、8天死于严重缺血缺氧性脑病,1例3天后死于肺大出血,4例7天后死于多脏器功能衰竭,死于原发病5例,感染2例,12例痊愈出院。结论 ECMO是救治严重呼吸、循环衰竭的最终治疗手段之一,严密的监护和有效的护理是保证ECMO成功的重要环节。

Objective To explore the nursing care of Extracorporeal Memberane Oxygenation （ECMO） in the Intensive Care Unit. Methods 28 cases were supported by V - V ECMO or V - A ECMO. Results 12 cases （ 42. 85 % ） survived. The failure reason of 16 dead cases were primary disease （ 6 case）, brain die （ 5 cases） and comphcation （5 cases）. It was import to monitor PaO2 , PaCO2, hemodynamic parameters, and ACT. The blood flow and mechanical assisted respiration should were monitored and adjusted in time. Contemporary, oxygenator and ECMO circuit were pay attention to manage and complications should were prevented. Conclusion It is import to nurse and monitor for ECMO patients in the Intensive Care Unit.