体外膜肺氧合治疗心源性休克合并急性呼吸窘迫综合征患者院外长途转运的护理  

Nursing care of patients with cardiogenic shock combined with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation and transferred outer-hospital in long distance

作　　者：王伟钟 马红丽[2] 王志娟[2] 周尧英[1] 俞建娣[1] 吴春燕[1] Wang Weizhong;Ma Hongli;Wang Zhijuan;Zhou Yaoying;Yu Jiandi;Wu Chunyan(Department of Intensive Care Units,Shaoxing People′s Hospital,Shaoxing 312000,China;Department of Nursing,Shaoxing People′s Hospital,Shaoxing 312000,China)

机构地区：[1]浙江省绍兴市人民医院重症医学科,312000 [2]浙江省绍兴市人民医院护理部,312000

出　　处：《中国实用护理杂志》2020年第10期774-777,共4页Chinese Journal of Practical Nursing

基　　金：绍兴市科技计划(2013B70070)。

摘　　要：目的总结2例行体外膜肺氧合(ECMO)治疗心源性休克合并急性呼吸窘迫综合征(ARDS)患者院外长途转运的护理经验。方法针对2例ECMO支持患者转运风险大[ECMO支持条件高(V-A模式,氧浓度100%,氧流量6~10 L/min)、呼吸机支持条件高(氧浓度100%,呼气末正压15~17 cmH2O)、转运距离远(196 km)、转运时间长(2 h36 min)]的特点,进行充分的转运前准备和专业的转运中护理,主要为组建专业的转运团队,准备充足的电源和气源,减少转运过程中ECMO和呼吸机支持的中断,提供合理的ECMO和呼吸机支持中断时的补救措施。结果2例患者均安全抵达目的地。结论进行充分的转运前准备和专业的转运中护理,能够有效避免和应对不良事件的发生,ECMO长途转运是安全可行的。Objective To summarize the nursing experience in 2 patients with cardiogenic shock combined with acute respiratory distress syndrome(ARDS)treated by extracorporeal membrane oxygenation(ECMO)and transferred outer-hospital in long distance.Methods There were many risk factors in this transport:high parameters of ECMO included V-A mode,100%oxygen,and a flow of oxygen from 6 L/min to 10 L/min.High ventilator parameters included oxygen concentration of 100%and positive end-expiratory pressure of 15-17 cmH2O(1 cmH2O=0.098 kPa).Transport distance was up to 196 km.And the transport time was up to 2 h 36 min.In this regard,we carried out adequate preparations before transport and professional cares during transport.The main points were as follows:setted up a professional transport team;prepared adequate power and oxygen supply;reduced the number of interruption of ECMO and ventilator support during transport;provided the reasonable remedial actions when ECMO and ventilator support were interrupted.Results Two patients arrived at the destination safely.Conclusions Adequate preparations before transport and professional cares during transport could effectively avoid and respond to the occurrence of adverse events,and it is feasible and safe to patients supported by ECMO for long distance outer-hospital transport.

关 键 词：体外膜肺氧合 心源性休克 急性呼吸窘迫综合征 患者转诊 

分 类 号：R473[医药卫生—护理学]