多学科合作在预防患者体外膜肺氧合辅助期间下肢压力性损伤中的应用

Application of multi-disciplinary teamwork in preventing patients from lower limb pressure injury during extracorporeal membrane oxygenation support

目的观察多学科合作(MDT)在体外膜肺氧合(ECMO)辅助期间预防患者下肢压力性损伤中的应用效果。方法选取2017年4月至2018年12月都医科大学附属北京安贞医院急诊危重症中心收治的17例ECMO辅助治疗患者,ECMO期间MDT成员组建包括体外循环医师、营养师、康复治疗师、责任护士、伤口专科护士、危重症专科护士的团队。以患者为中心、通过MDT,为患者提供全面系统又依个体定制的治疗、护理和康复一体化服务。观察患者预后情况。结果 17例患者ECMO辅助时间(8±5) d。17例患者均采用股动脉、股静脉插管,侧孔小辫肢体远端供血。其中11例患者好转出院,6例患者死亡。其中1例发生下肢压力性损伤,经针对性处理好转。结论通过建立医师模式,由不同领域的专家对ECMO辅助治疗患者的全身及局部肢体情况进行专业化、个体化的指导,有效预防了患者下肢压力性损伤的发生。

Objective To observe the effect of multi-disciplinary teamwork(MDT) in the prevention of lower extremity pressure injury in patients undergoing extracorporeal membrane oxygenation(ECMO). Methods Seventeen patients undergoing ECMO were selected from Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University from April 2017 to December 2018. MDT members of ECMO consisted of cardiopulmonary bypass physicians, nutritionists, rehabilitation therapists, responsible nurses, wound nurses and critical care nurses. Individualized comprehensive and systematic treatment, nursing and rehabilitation services were performed based on MDT. The prognosis of patients was observed. Results ECMO support time of 17 patients was (8±5)days. All patients had femoral artery and femoral vein intubation and distal blood supply from lateral foramen braided limbs. Among them, 11 patients recovered well and 6 patients died. One of them suffered from lower extremity pressure injury, which was improved after targeted treatment. Conclusion MDT with specialized experts in different fields can provide professional and customized guidance for the recovery of whole body and local limbs in patients undergoing ECMO, effectively prevent the occurrence of pressure injury in lower limbs.