Weaning nursing of a patient with extracorporeal membrane oxygenation after aortic dissection complicated with cardiogenic shock

doi:10.3761/j.issn.0254-1769.2023.16.013

Abstract

Abstract:

To summarize the weaning nursing practice of a patient with postoperative cardiogenic shock complicated by acute type A aortic dissection receiving veno-arterial extracorporeal membrane oxygenation. The key points of nursing were as follows：the interprofessional team cooperation model was adopted，and the extracorporeal membrane oxygenation special class team was established；a goal-oriented extracorporeal membrane oxygenation management plan was formulated and individualized pre-weaning nursing was implemented. The evaluation and preparation before weaning should be improved，and the cooperation during weaning and the observation after weaning should be strengthened. After careful treatment and nursing，extracorporeal membrane oxygenation was successfully removed on the 7th day after operation，and the patient recovered and was discharged on the 10th day after surgery，and the follow-up was in good condition.

Key words: Extracorporeal Membrane Oxygenation, Aortic Dissection, Shock，Cardiogenic, Weaning, Cardiovascular Diseases, Nursing Care

摘要：

总结1例急性A型主动脉夹层术后并发心源性休克行静脉-动脉体外膜肺氧合辅助治疗患者的撤机护理实践。护理要点如下：采用跨专业团队合作模式，组建体外膜肺氧合专班小组；制订目标导向性体外膜肺氧合管理方案，实施个体化撤机前护理；完善撤机前评估与准备，加强撤机中的配合及撤机后的观察。该患者经过精心的治疗与护理，术后第7天成功撤除体外膜肺氧合，术后第10天康复出院，随访时状态良好。

关键词: 体外膜肺氧合, 主动脉夹层, 休克，心源性, 撤机, 心血管疾病, 护理

WANG Yan, WANG Zheyun, ZHAO Weiwei, YU Yun, ZHANG Chi, KANG Yubei. Weaning nursing of a patient with extracorporeal membrane oxygenation after aortic dissection complicated with cardiogenic shock[J]. Chinese Journal of Nursing, 2023, 58(16): 1996-1999.

王岩, 王哲芸, 赵玮玮, 余云, 张弛, 康玉贝. 1例主动脉夹层术后并发心源性休克行体外膜肺氧合患者的撤机护理[J]. 中华护理杂志, 2023, 58(16): 1996-1999.

References 10

[1]	宋雨, 吴龙, 董念国. 急性A型主动脉夹层合并脏器灌注不良综合征的治疗现状与进展[J]. 中华胸心血管外科杂志, 2022, 38(2):117-122.
	Song Y, Wu L, Dong NG. The present situation and progress of treatment of acute type A aortic dissection with organ malperfusion syndrome[J]. Chin J Thorac Cardiovasc Surg, 2022, 38(2):117-122.
[2]	弓文清, 刘艳, 周玲, 等. A型主动脉夹层累及冠状动脉超声表现及预后[J]. 中国医学影像技术, 2021, 37(4):527-530.
	Gong WQ, Liu Y, Zhou L, et al. Ultrasonic manifestations and prognosis of Stanford type A aortic dissection with involvement of coronary artery[J]. Chin J Med Imaging Technol, 2021, 37(4):527-530.
[3]	van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock:a scientific statement from the American heart association[J]. Circulation, 2017, 136(16):e232-e268.
[4]	Amin F, Lombardi J, Alhussein M, et al. Predicting survival after VA-ECMO for refractory cardiogenic shock:validating the SAVE score[J]. CJC Open, 2021, 3(1):71-81. DOI URL
[5]	刘淼淼, 郭锋伟, 刘锋锋, 等. 静脉-动脉体外膜氧合辅助心源性休克的危险因素分析:一项连续5年的回顾性分析[J]. 实用医学杂志, 2022, 38(6):743-748.
	Liu MM, Guo FW, Liu FF, et al. Risk factors of veno-arterial extracorporeal membrane oxygenation in treating cardiogenic shock:a consecutive 5-year retrospective study[J]. J Pract Med, 2022, 38(6):743-748.
[6]	中国心胸血管麻醉学会, 中华医学会麻醉学分会, 中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版)[J]. 中国循环杂志, 2020, 35(11):1052-1063.
	Chinese Society of Cardiothoracic and Vascular Anesthesiology,Chinese Society of Anesthesiology, Chinese Society of Anesthesiology,Chinese Association of Anesthesiologists, et al. Expert consensus on the clinical application of adult extracorporeal membrane oxygenation under different conditions(2020 edition)[J]. Chin Circ J, 2020, 35(11):1052-1063.
[7]	王悦, 宋辉, 毕雪茜, 等. 多学科多专业协同下医疗队物资配置方案的研究[J]. 中华护理杂志, 2020, 55(S1):279-282.
	Wang Y, Song H, Bi XQ, et al. Research on material allocation scheme of medical team under multi-disciplinary and multi-professional cooperation[J]. Chin J Nurs, 2020, 55(S1):279-282.
[8]	钟劲, 于翠香, 陶红梅, 等. 液体管理策略在肺移植术后患者中的应用[J]. 中华护理杂志, 2019, 54(5):678-681. DOI
	Zhong J, Yu CX, Tao HM, et al. Application of fluid management strategy in patients received lung transplantation[J]. Chin J Nurs, 2019, 54(5):678-681. DOI
[9]	赵明曦, 李奇, 罗红波, 等. 中心静脉压测量的最佳证据总结[J]. 中华护理杂志, 2021, 56(10):1552-1560. DOI
	Zhao MX, Li Q, Luo HB, et al. Measurement techniques of central venous pressure in adult patients:a summary of best evidence[J]. Chin J Nurs, 2021, 56(10):1552-1560. DOI
[10]	胡亚玲, 兰美娟, 汪春海, 等. 左心室辅助装置与体外膜肺氧合治疗1例心力衰竭患者的护理[J]. 中华护理杂志, 2021, 56(11):1707-1710. DOI
	Hu YL, Lan MJ, Wang CH, et al. Postoperative nursing care of a patient with heart failure treated by left ventricular assist device combined with central extracorporeal membrane oxygenation[J]. Chin J Nurs, 2021, 56(11):1707-1710. DOI

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