1例重症胎粪吸入综合征患儿行ECMO联合CRRT及NO治疗的护理

Care of one critically ill infant with meconium aspiration syndrome treated with ECMO combined with CRRT and NO

目的总结1例重症胎粪吸入综合征(MAS)患儿行体外膜肺氧合(ECMO)联合连续肾脏替代疗法(CRRT)及一氧化氮(NO)治疗的护理经验。方法ECMO联合CRRT及NO治疗管理中,全程实施团队协作;动态监测凝血功能,合理使用抗凝药物;实施精细化的液体管理;防治感染;开展个性化家庭教育。结果ECMO治疗26 h后,患儿出现肺动脉高压危象,立即予NO吸入,症状无改善,经多学科医护团队评估,考虑ECMO管道堵管,取得家属同意后立即更换ECMO装置,因患者全身渗漏综合征严重,尿少,行床边CRRT治疗,经过25 d的住院救治,痊愈出院。结论ECMO联合CRRT及NO治疗是抢救重症胎粪吸入综合征患儿的重要方法,各团队高质量配合与协作及优质护理是成功救治本例患儿的关键所在。

Objective To summarize the nursing experience of an infant with severe meconium aspiration syndrome(MAS)treated with extracorporeal membrane oxygenation(ECMO)combined with continuous renal replacement therapy(CRRT)and nitric oxide(NO).Methods For the infant with MAS,the focus and difficulty of nursing in the process of treatment included the following aspects:strengthened communication and cooperation in the multidisciplinary medical team;dynamic monitoring of coagulation and rational use of anti-coagulation medication;delicacy fluid management;prevention and treatment of infection and individualized family education.Results After 26 hours of ECMO treatment,the child occurred pulmonary hypertension crisis.NO was inhaled immediately,but it did not work.After the assessment by MDT,given the pipe blockage of ECMO,the ECMO device was replaced immediately with the consent of the family.Because of the concurrent severe systemic leakage syndrome and less urine,bedside CRRT treatment was performed.After 25 days of hospitalization,the infant was recovered and discharged.Conclusion ECMO combined with CRRT and NO therapy plays a crucial role in rescuing the infant with MAS,and the cooperation of MDT and high-quality care is the guarantee of successful treatment.