1例立克次体感染合并爆发性心肌炎老年患者的护理体会  

Nursing of an elderly patient with rickettsial infection combined with fulminant myocarditis

作　　者：吴正男 王明明[1] 赵荣华[2] 苏燕[2] 任抒文 李提提 WU Zhengnan;WANG Mingming;ZHAO Ronghua;SU Yan;REN Shuwen;LI Titi(Department of Nursing,People's Hospital Affiliated to Jiangsu University,Zhenjiang 212003;Department of Critical Care Medicine,Anqing Municipal Hospital,Anhui Province,Anqing 246001,China)

机构地区：[1]江苏大学附属人民医院护理部,212003 [2]安徽省安庆市立医院重症医学科,246001

出　　处：《中国老年保健医学》2025年第1期149-152,共4页Chinese Journal of Geriatric Care

基　　金：安徽省2024年度安庆市立医院护理专项课题基金项目(编号:2024SLHLK02)。

摘　　要：本研究通过整理和总结1例立克次体感染合并爆发性心肌炎老年患者的护理过程,探讨老年危重患者的有效护理策略。护理要点如下:通过连续性肾脏替代治疗进行容量管理;高流量静脉-动脉体外膜肺氧合治疗时予持续抗凝监测,予消化道出血的处理;加强管道的管理,保持流量正常和预防非计划脱管;评估患者呼吸功能,实施个性化气道廓清技术方案;多学科合作,实施各阶段渐进式肢体康复锻炼;目标导向性镇痛镇静,预防老年患者谵妄发生;通过预见性护理,防控发生院内感染。研究结果表明,老年立克次体感染合并爆发性心肌炎患者病情变化迅速、危重程度和病死率高,因此早期预测病情转归并及时进行多脏器替代治疗和护理,加强危重患者的康复锻炼,是降低患者死亡率和提高患者预后生活质量的重要途径。本案例为临床护理立克次体感染合并爆发性心肌炎老年患者提供了有价值的经验和参考。The aim of this study was to explore effective nursing strategies for elderly critically ill patients by organizing and summarizing the nursing process of an elderly patient with rickettsial infection combined with fulminant myocarditis.Nursing key points:volume management through continuous renal replacement therapy;continuous anticoagulation monitoring during high-flow veno-arterial extracorporeal membrane pulmonary oxygenation therapy,and management of gastrointestinal bleeding;strengthening the management of tubes,maintaining normal flow and preventing unplanned de-tubing;evaluating the patient's respiratory function,and implementing individualized airway contouring technical programs;multidisciplinary cooperation,and implementation of gradual limb rehabilitation exercise in all stages;goal-oriented analgesia and sedation to prevent the occurrence of delirium in elderly patients;and prevention and control of the occurrence of nosocomial infections through anticipatory care.The results of the study show that the condition of elderly patients with rickettsial infection combined with fulminant myocarditis changes rapidly,the degree of criticality and the high rate of death,therefore,early prediction of the regression of the disease and timely multi-organ replacement therapy and care;strengthen the rehabilitation exercise of critically ill patients is an important way to reduce the mortality rate of the patients and to improve the prognosis of the patients'quality of life.This case provides valuable experience and reference for clinical care of elderly patients with rickettsial infection combined with fulminant myocarditis.

关 键 词：立克次体感染 爆发性心肌炎 体外膜肺氧合治疗 连续性肾脏替代治疗 抢救 重症监护 

分 类 号：R473.5[医药卫生—护理学]