体外膜肺氧合联合连续性肾脏替代治疗患者的护理

Nursing care of a patient treated by extracorporeal membrane oxygenation combined with continuous renal replacement therapy

总结1例多发伤并发多器官功能障碍综合征行体外膜肺氧合联合连续性肾脏替代治疗患者的护理体会。针对该患者体外膜肺氧合管路固定、凝血监测、血流动力学紊乱等安全问题,给予胸腔闭式引流联合机械通气护理及压力性损伤的预防,并对常规护理措施进行调整;根据患者意识、ICU活动评分给予以护士为主导的早期分级康复活动方案,其中肢体功能锻炼、主动活动和被动活动结合、保证活动安全是护理难点也是关键点。经过26 d治疗及护理,患者好转出院。出院后随访2个月,状况良好。

To summarize the nursing experience of a patient with multiple injury complicated with multiple organ dysfunction syndrome who underwent extracorporeal membrane oxygenation combined with continuous renal replacement therapy.Conventional nursing measures were adjusted for safety problems such as pipeline fixation of extracorporeal membrane lung oxygenation,coagulation monitoring,hemodynamic disorders.Thoracic closed drainage combined with mechanical ventilation nursing and pressure injury prevention were given.According to patients’consciousness and ICU activity score,early graded rehabilitation activity program led by nurses was given,among which physical function exercise,combination of active and passive activities,and activity safety were the difficulties and key points of nursing.After 26 days of treatment and nursing,the patient’s condition was improved and he was discharged.He was in good condition after 2 months of follow-up.