2例暴发性心肌炎清醒患者使用体外膜肺氧合联合主动脉内球囊反搏治疗的护理

doi:10.3761/j.issn.0254-1769.2021.12.006

摘要/Abstract

摘要：

总结2例暴发性心肌炎患者清醒状态下应用体外膜肺氧合联合主动脉内球囊反搏治疗的护理经验。护理要点包括：导管的护理;全身抗凝的护理;呼吸、循环及血流动力学的监护;疼痛的护理;肌力训练;饮食和心理护理。经过精心的治疗和护理,2例患者病情稳定,转普通病房继续治疗。

关键词: 暴发性心肌炎, 清醒患者, 体外膜肺氧合, 主动脉内球囊反搏, 护理

Abstract:

To summarize the nursing experience of 2 patients with fulminant myocarditis with awake V-A extracorporeal membrane pulmonary oxygenation and intra-aortic balloon pump. Nursing points：nursing care of catheter;nursing care of systemic anticoagulation;monitoring of respiratory,circulation and hemodynamics;nursing care of pain;training of myodynamia;dietary and psychological care. After treatment and nursing care,2 patients were transferred to the general ward for further treatment.

Key words: Fulminant Myocarditis, Awake Patients, Extracorporeal Membrane Oxygenation, Intra-Aortic Balloon Pump, Nursing Care

柳红娟, 乔莹, 陈晗睿, 崔娇, 罗灿, 陈雪梅, 唐静, 李宁宁. 2例暴发性心肌炎清醒患者使用体外膜肺氧合联合主动脉内球囊反搏治疗的护理[J]. 中华护理杂志, 2021, 56(12): 1796-1799.

LIU Hongjuan, QIAO Ying, CHEN Hanrui, CUI Jiao, LUO Can, CHEN Xuemei, TANG Jing, LI Ningning. Nursing care of 2 patients with fulminant myocarditis with awake V-A extracorporeal membrane pulmonary oxygenation and intra-aortic balloon pump[J]. Chinese Journal of Nursing, 2021, 56(12): 1796-1799.

参考文献 22

[1]	Li YN, Yan SJ, Gao SZ, et al. Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock:a systematic review and meta-analysis[J]. Eur J Cardiothorac Surg, 2019, 55(3):395-404. DOI URL
[2]	张明翰, 封加涛, 罗建军, 等. 清醒V-A ECMO在暴发性心肌炎患者中的临床应用[J]. 中国现代手术学杂志, 2020, 24(2):94-98.
	Zhang MH, Feng JT, Luo JJ, et al. Clinical application of awake V-A ECMO for patients with fulminant myocarditis[J]. Chin J Mod Oper Surg, 2020, 24(2):94-98.
[3]	Deng L, Xia Q, Chi C, et al. Awake veno-arterial extracorporeal membrane oxygenation in patients with perioperative period acute heart failure in cardiac surgery[J]. J Thorac Dis, 2020, 12(5):2179-2187. DOI PMID
[4]	Warren WA, Walter RJ, Mason PE. Rebuttal From Dr Warren et al[J]. Chest, 2020, 158(1):41-42. DOI URL
[5]	汪贝, 汪晓筱, 张健, 等. 体外膜肺氧合桥接心脏移植术的护理[J]. 中华护理杂志, 2019, 54(8):1235-1238.
	Wang B, Wang XX, Zhang J, et al. The nursing for patients with extracorporeal membrane oxygenation before heart transplantation[J]. Chin J Nurs, 2019, 54(8):1235-1238.
[6]	Park BS, Lee WY, Lim JH, et al. Delayed repair of ventricular septal rupture following preoperative awake extracorporeal membrane oxygenation support[J]. Korean J Thorac Cardiovasc Surg, 2017, 50(3):211-214. DOI URL
[7]	Kearns SK, Hernandez OO. “Awake” extracorporeal membrane oxygenation as a bridge to lung transplant[J]. AACN Adv Crit Care, 2016, 27(3):293-300. PMID
[8]	Lang G, Kim D, Aigner C, et al. Awake extracorporeal membrane oxygenation bridging for pulmonary retransplantation provides comparable results to elective retransplantation[J]. J Heart Lung Transplant, 2014, 33(12):1264-1272. DOI URL
[9]	Alozie A, Kische S, Birken T, et al. Awake extracorporeal membrane oxygenation(ECMO)as bridge to recovery after left main coronary artery occlusion:a promising concept of haemodynamic support in cardiogenic shock[J]. Heart Lung Circ, 2014, 23(10):e217-e221. DOI URL
[10]	郭怡琳. 《成人暴发性心肌炎诊断与治疗中国专家共识》:以生命支持为依托的综合救治方案[J]. 内科急危重症杂志, 2017, 23(6):454-455.
	Guo YL. Chinese expert consensus on the diagnosis and treatment of adult fulminant myocarditis-a comprehensive treatment plan based on life support[J]. J Crit Care Intern Med, 2017, 23(6):454-455.
[11]	罗小龙, 黄亮, 李洋. 清醒状态下体外膜肺氧合治疗的研究进展[J]. 中华急诊医学杂志, 2020, 29(7):1007-1010.
	Luo XL, Huang L, Li Y. Research progress of extracorporeal membrane oxygenation therapy in awake state[J]. Chin J Emerg Med, 2020, 29(7):1007-1010.
[12]	Wang L, Xing Z. Short-term outcomes of intra-aortic balloon pump combined with venoarterial extracorporeal membrane oxygenation:a systematic review and meta-analysis[J]. Artif Organs, 2019, 43(6):561-568. DOI PMID
[13]	Bréchot N, Demondion P, Santi F, et al. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation[J]. Eur Heart J Acute Cardiovasc Care, 2018, 7(1):62-69. DOI URL
[14]	中华医学会心血管病学分会精准医学学组, 中华心血管病杂志编辑委员会, 成人暴发性心肌炎工作组. 成人暴发性心肌炎诊断与治疗中国专家共识[J]. 内科急危重症杂志, 2017, 23(6):443-453.
	Working Group of Adult Fulminant Myocarditis, Chinese Journal of Cardiology Editorial Committee, Precision Medicine Group,Chinese Association of Cardiology. Chinese expert consensus on the diagnosis and treatment of adult fulminant myocarditis[J]. J Crit Care Intern Med, 2017, 23(6):443-453.
[15]	石秀茹, 郭远, 郑凯兰, 等. 1例危重型新型冠状病毒肺炎患者并发消化道出血应用体外膜肺氧合治疗的护理[J]. 中华护理杂志, 2020, 55(S1):675-677.
	Shi XR, Guo Y, Zheng KL, et al. Nursing care of 1 critical COVID-19 patient complicated with gastrointestinal bleeding treated with extracorporeal membrane oxygenation[J]. Chin J Nurs, 2020, 55(S1):675-677.
[16]	Bonicolini E, Martucci G, Simons J, et al. Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation:a narrative review of incidence,prevention,monitoring,and treatment[J]. Crit Care, 2019, 23(1):266. DOI PMID
[17]	Gu K, Guan Z, Lin X, et al. Numerical analysis of aortic hemodynamics under the support of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump[J]. Comput Methods Programs Biomed, 2019, 182:105041. DOI URL
[18]	曾妃, 梁江淑渊, 金小娟, 等. 6例特重度烧伤患者使用体外膜肺氧合联合连续性肾脏替代治疗的护理[J]. 中华护理杂志, 2021, 56(3):364-367.
	Zeng F, Liang JSY, Jin XJ, et al. Nursing care of 6 patients with severe burn treated with extracorporeal membran pulmonary oxygena tion and continuous renal replacement therapy[J]. Chin J Nurs, 2021, 56(3):364-367.
[19]	Langer T, Santini A, Bottino N, et al. “Awake” extracorporeal membrane oxygenation(ECMO):pathophysiology,technical considerations,and clinical pioneering[J]. Crit Care, 2016, 20(1):150. DOI URL
[20]	刘桂英, 应巧燕, 李若祎, 等. 体外膜肺氧合治疗患者早期活动的研究进展[J]. 中华护理杂志, 2018, 53(6):724-729.
	Liu GY, Ying QY, Li RY, et al. Research progress of early mobilization in patients with extracorporeal membrane oxygenation[J]. Chin J Nurs, 2018, 53(6):724-729.
[21]	Schneider TM, Bence T, Brettner F. “Awake” ECCO2R superseded intubation in a near-fatal asthma attack[J]. J Intensive Care, 2017, 5:53. DOI URL
[22]	Mirabel M, Luyt CE, Leprince P, et al. Outcomes,long-term quality of life,and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support[J]. Crit Care Med, 2011, 39(5):1029-1035. DOI URL