体外心肺复苏联合冠状动脉介入治疗心搏骤停患者的护理

Nursing care of patients with cardiac arrest treated by extracorporeal cardiopulmonary resuscitation combined with coronary intervention

总结10例急性ST段抬高型心肌梗死并发心搏骤停患者行体外心肺复苏联合急诊经皮冠状动脉介入治疗的急救护理经验。针对疾病病程进展快、心搏骤停情况下建立体外膜肺氧合难度大、经皮冠状动脉介入治疗风险高、术后神经系统功能恢复差、循环不稳定等特点,采取组建多学科协作急救护理团队、精准实施心肺复苏术、配合医生快速实施体外膜肺氧合及经皮冠状动脉介入治疗、做好患者体温管理与神经功能监测、稳定体外心肺复苏后患者血流动力学等护理措施。10例患者中5例病情好转出院,3例因神经功能障碍和(或)合并多脏器功能衰竭放弃治疗出院,1例转上级医院行心脏移植治疗,1例死亡。

To summarize emergency care experience of 10 patients with acute ST-segment elevation myocardial infarction complicated by sudden cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation combined with the emergency percutaneous coronary intervention. In view of the characteristics such as the rapid progression of the disease,the difficulty of establishing extracorporeal membrane oxygenation in the case of sudden cardiac arrest,the high risk of percutaneous coronary intervention,the poor postoperative recovery of nervous system function,and the instability of circulation,the caring measures were adopted,including the establishment of a multidisciplinary collaborative emergency care team,precise implementation of cardiopulmonary resuscitation,cooperation with doctors for rapid implementation of extracorporeal membrane oxygenation and percutaneous coronary intervention,temperature management and neurological function monitoring,stabilization of patient hemodynamics after extracorporeal cardiopulmonary resuscitation. Among the 10 patients,five patients’ conditions were improved and were discharged,three patients were discharged after giving up treatment due to neurological dysfunction and/or combined multiple organ failure,one patient was transferred to a higher-level hospital for heart transplantation,and one patient died.