经皮冠状动脉介入联合体外膜肺氧合治疗急性心肌梗死合并急性左心衰竭患者的护理及讨论

Nursing care of patients with acute myocardial infarction combined with acute left heart failure treatedwith PCI and ECMO

目的总结经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)联合体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗急性心肌梗死术中合并急性左心衰竭患者的护理经验。方法对2例经PCI联合ECMO治疗急性心肌梗死术中合并急性左心衰竭患者术后转入ICU后呼吸道的情况、液体管理效果、ECMO参数、镇静镇痛管理效果、脉搏指示连续心排血量监测参数(pulse indicating continuous cardiac output monitoring,PICCO)进行综合分析,制订专业化、精细化的护理方案。结果2例患者在重症监护室(intensive care unit,ICU)住院期间均未发生严重并发症,92~103 h后按计划撤除ECMO,163~214 h后拔除人工气道。2例患者病情好转后分别在入住ICU第27天、第34天转出ICU继续治疗。结论采用精细化液体管理策略是维护左心功能的重要手段,是提高救治成功率的重要保障。撤除ECMO后,加强PICCO指标监测是进行镇静唤醒、早期活动的重要依据。

Objective To summarize the nursing experience of percutaneous coronary intervention(PCI)combined with extracorporeal membrane oxygenation(ECMO)in patients with acute myocardial infarction complicated with acute left heart failure.Method A comprehensive analysis was performed on the status of the respiratory tract,fluid management effect,ECMO parameters,sedation and analgesia management effect,and pulse indicating continuous cardiac output monitoring(PICCO)parameters in patients with intraoperative acute myocardial infarction complicated with acute left heart failure in ICU after PCI combined with ECMO,and specialized and refined nursing plans were developed.Result No serious complications occurred in the 2 patients during their stay in ICU.ECMO was removed as planned(92-103)h later,and artificial airway was removed(163-214)h later.Both of them were transferred out of ICU to continue treatment on the 27th and 34th days respectively.Conclusions The use of refined liquid management strategy is important to maintain left cardiac function and improve the success rate of treatment.After ECMO removed,strengthening PICCO index monitoring is an important basis for early sedation and arousal activities.