体外膜肺氧合串联连续性血液净化治疗前纵隔淋巴瘤患儿的护理  

Nursing care of a child with anterior mediastinal lymphoma supported with extracorporeal membrane oxygenation and continuous blood purification

作　　者：谢王芳[1] 楼晓芳[2] 诸纪华[2] 徐彬[3] XIE Wangfang;LOU Xiaofang;ZHU Jihua;XU Bin

机构地区：[1]浙江大学医学院附属儿童医院综合ICU,杭州市310003 [2]浙江大学医学院附属儿童医院护理部,杭州市310003 [3]浙江大学医学院附属儿童医院超声科,杭州市310003

出　　处：《中华急危重症护理杂志》2023年第2期147-150,共4页Chinese Journal of Emergency and Critical Care Nursing

基　　金：2019年浙江省卫生厅课题资助项目(2019KY440);2020年浙江省卫生厅课题资助项目(2020KY613)。

摘　　要：总结1例前纵隔淋巴瘤并发严重气道梗阻及上腔静脉压迫患儿的抢救和护理体会。护理要点:做好纵隔淋巴瘤局部压迫导致呼吸困难的早期识别,有效应用体外膜肺氧合干预;在体外膜肺氧合串联连续性血液净化运行期间密切观察病情,动态评估气道梗阻症状,持续监测上腔静脉压迫情况;及时观察并有效处理低血压、出血等并发症以及高血钾、低血钙等肿瘤溶解综合征。经过精心的治疗和护理,体外膜氧合运行12d后成功撤离,患儿于入科第20天病情恢复平稳,转至血液科继续进行专科治疗。This paper summarized the rescue and the nursing care of a case of anterior mediastinal lymphoma complicated with severe airway obstruction and superior vena cava compression. Key nursing pointes included early identification of dyspnea caused by local compression of mediastinal lymphoma,effective intervention of extracorporeal membrane oxygenation. During the operation of extracorporeal membrane oxygenation combined with continuous blood purification,the patient was closely observed,symptoms of airway obstruction were dynamically evaluated,and pressure of superior vena cava was continuously monitored. We timely observed and effectively treated hypotension,bleeding and other complications,tumor lysis syndrome such as hyperkalemia and hypocalcemia.After careful treatment and nursing,the extracorporeal membrane lung machine was successfully evacuated after 12days of operation. The patient’s condition recovered steadily on the 20th day of admission and was transferred to hematology department for further specialized treatment.

关 键 词：体外膜肺氧合 连续性肾脏替代疗法 淋巴瘤 儿童 危重病护理 

分 类 号：R473.73[医药卫生—护理学]