先天性心脏病产妇体外膜肺氧合期间继发纤溶亢进的护理  

Nursing care of hyperfibrinolysis during extracorporeal membrane oxygenation therapy for a puerpera with congenital heart disease

作　　者：鲁玉萍 曾妃[1] LU Yuping;ZENG Fei

机构地区：[1]浙江大学医学院附属第二医院护理部,杭州市310051

出　　处：《中华急危重症护理杂志》2024年第10期937-940,共4页Chinese Journal of Emergency and Critical Care Nursing

摘　　要：总结1例先天性心脏病产妇体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗期间纤溶亢进的护理体会。针对患者疾病进展迅速,无法即刻行手术治疗,采用静脉-动脉ECMO(VA-ECMO)辅助支持治疗,其间患者凝血系统异常活化,继发纤溶亢进。护理要点:VA-ECMO纤溶亢进的早期预警;ECMO膜肺快速衔接无缝更换;以目标出入量为导向的容量管理;以产妇为主体的个体化护理,其中ECMO膜肺更换是该案例的难点及重点。经过精心治疗及护理,患者病情趋于稳定,VA-ECMO支持第38天顺利撤除ECMO,入科第41天成功拔除气管插管,入院72 d后病情稳定出院。To summarize the nursing experience of hyperfibrinolysis during extracorporeal membrane oxygenation(ECMO)therapy in a puerpera with congenital heart disease.In view of the rapid progression of the disease,the patient could not be immediately treated with surgery,and the veno-arterial ECMO(VA-ECMO)assisted supportive treatment was used,during which the patient's coagulation system was abnormally activated and secondary hyperfibrinolysis occurred.Nursing points included early warning of VA-ECMO hyperfibrinolysis,rapid and seamless replacement of ECMO oxygenator,target volume-oriented capacity management,individualized nursing with the puerperal as the main body.ECMO oxygenator replacement was the dificulty and focus of this case.Afier careful treatment and nursing,the patient's condition tended to be stable.ECMO was successfully removed on the 38th day supported by VA-ECMO,and tracheal intubation was successfully removed on the 4lst day after admission.The patient's condition was stable and discharged after 72d admission.

关 键 词：心脏缺损 先天性 肺动脉高压 体外膜肺氧合作用 继发纤溶亢进 危重病护理 

分 类 号：R473.71[医药卫生—护理学]