抗中性粒细胞胞质抗体相关性血管炎患者应用体外膜肺氧合的护理  

Nursing of anti-neutrophil cytoplasmic antibody associated vasculitis treated with extracorporeal membrane oxygenation

作　　者：张润节 郭红艳[1] ZHANG Runjie;GUO Hongyan

机构地区：[1]北京大学第一医院护理部,北京市100034

出　　处：《中华急危重症护理杂志》2023年第10期923-926,共4页Chinese Journal of Emergency and Critical Care Nursing

摘　　要：总结1例抗中性粒细胞胞质抗体相关性血管炎合并弥漫性肺泡出血患者应用ECMO辅助治疗的护理体会。针对该患者氧合难以维持、肺泡持续出血,采取静脉-静脉体外膜肺氧合辅助治疗。护理要点:预防和控制感染、俯卧位通气护理、精准化容量管理、严密监测凝血和出血、阶段式康复运动以及个性化心理支持。其中初期抗凝治疗适用性监测及抗凝治疗后管理是该案例的特点和重点。患者第11天成功撤除体外膜肺氧合,第13天脱离机械通气,第30天转出ICU,17 d后顺利出院。To summarize the nursing experience of ECMO for a patient with anti-neutrophil cytoplasmic antibody(ANCA)associated vasculitis complicated with diffuse alveolar hemorrhage.It was difficult to maintain oxygenation and the alveolar bleeding continued,so vein-vein extracorporeal membrane oxygenation was used as adjuvant therapy.The key points of nursing included infection prevention and control,prone ventilation care,precision volume management,close monitoring of clotting and bleeding,phased early mobilization,personalized psychological support.Monitoring of applicability in the early stage of anticoagulant therapy and management after anticoagulant therapy were the characteristics and focus of this case.The patient was successfully removed from ECMO on the 1lth day and withdrew from mechanical ventilation 2 days later,and he was transferred out of ICU on the 3Oth day and discharged successfully 17 days later.

关 键 词：抗中性粒细胞胞质抗体 肺泡 出血 体外膜氧合作用 危重病护理 

分 类 号：R473.5[医药卫生—护理学]