静脉-动脉体外膜肺氧合护理标准化方案在复杂高危冠心病患者中的应用研究

doi:10.3761/j.issn.0254-1769.2026.01.009

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (1): 63-69.DOI: 10.3761/j.issn.0254-1769.2026.01.009

静脉-动脉体外膜肺氧合护理标准化方案在复杂高危冠心病患者中的应用研究

郭恩慧¹(), 朗秋燕¹, 温汉春¹, 甘衍梅², 王书林¹, 李高叶²^,^*()

1.广西医科大学第一附属医院重症医学科南宁市 530021
2.广西医科大学第一附属医院心血管内科南宁市 530021

收稿日期:2025-08-04 出版日期:2026-01-10 发布日期:2026-01-04
*通讯作者: 李高叶，E-mail：1623433607@qq.com
作者简介:郭恩慧：男，本科（硕士在读），主管护师，呼吸治疗师，E-mail：383529622@qq.com
基金资助:
国家药品监督管理局药物研究与评价重点实验室开放课题(CDR2024X01002)

Study on the application of a standardized nursing protocol for venous-arterial extracorporeal membrane oxygenation in patients with complex high-risk coronary heart disease

GUO Enhui¹(), LANG Qiuyan¹, WEN Hanchun¹, GAN Yanmei², WANG Shulin¹, LI Gaoye²^,^*()

1. Department of Critical Care Medicine，the First Affiliated Hospital of Guangxi Medical University，Nanning 530021，China
2. Department of Cardiology，the First Affiliated Hospital of Guangxi Medical University，Nanning 530021，China

Received:2025-08-04 Online:2026-01-10 Published:2026-01-04
* Corresponding author: LI Gaoye，E-mail：1623433607@qq.com
Funding program:
Open Project of Key Laboratory of Drug Research and Evaluation，National Medical Products Administration(CDR2024X01002)

摘要/Abstract

摘要：

目的观察静脉-动脉体外膜肺氧合护理标准化方案在复杂高危冠心病治疗中的应用效果，为临床护理实践提供参考。方法采用便利抽样法，选取2020年4月至2025年6月南宁市某三级甲等综合医院体外膜肺氧合培训基地收治的复杂高危冠心病患者（complex high-risk intervention patients，CHIP）作为研究对象，所有患者均在静脉-动脉体外膜肺氧合辅助下进行介入治疗。试验组为2024年1月至2025年6月收治的26例CHIP，采用静脉-动脉体外膜肺氧合护理标准化方案；对照组为2020年4月至2023年12月收治的30例CHIP，采用常规护理方案。比较两组的物品到位时间、管路预充时间、完成置管时间、医护合作程度、体外膜肺氧合辅助时间及并发症发生率。结果两组均无样本脱落。试验组的物品到位时间、管路预充时间、完成置管时间、体外膜肺氧合辅助时间及并发症发生率均低于对照组，医护合作程度分值高于对照组，差异具有统计学意义（均P<0.001）。结论静脉-动脉体外膜肺氧合护理标准化方案可优化CHIP介入治疗的护理流程，提高关键环节的时效性和医护合作程度，降低并发症发生率。

关键词: 冠心病, 经皮冠状动脉介入治疗, 体外膜肺氧合, 护理流程, 并发症

Abstract:

Objective To evaluate the effectiveness of a standardized nursing protocol for venous-arterial extracorporeal membrane oxygenation（VA-ECMO） in treating complex high-risk coronary heart disease and to provide a reference for clinical nursing practice. Methods Using convenience sampling，we selected 56 complex high-risk intervention patients（CHIP） who underwent interventional treatment with VA-ECMO assistance at a tertiary A hospital in Nanning，Guangxi，from April 2020 to June 2025. The experimental group comprised 26 patients admitted from January 2024 to June 2025 who received a standardized nursing protocol for VA-ECMO-assisted complex high-risk coronary intervention. The control group comprised 30 patients admitted from April 2020 to December 2023 who received conventional nursing protocols. We compared equipment availability time，circuit pre-charging time，catheterization completion time，degree of nurse-physician collaboration，ECMO assistance duration，and complication incidence between groups. Results No sample dropped out. The experimental group demonstrated shorter times for equipment availability，circuit pre-charging，catheterization completion，and ECMO assistance duration compared to the control group. The experimental group also had a lower complication incidence and higher medical-nursing cooperation scores. All differences were statistically significant（P<0.001）. Conclusion The standardized nursing protocol for VA-ECMO-assisted CHIP intervention optimizes the nursing process，improves the timeliness of key VA-ECMO assistance steps and medical-nursing cooperation，and reduces complication incidence.

Key words: Coronary Heart Disease, Percutaneous Coronary Intervention, Extracorporeal Membrane Oxyge-nation, Nursing Process, Complications

郭恩慧, 朗秋燕, 温汉春, 甘衍梅, 王书林, 李高叶. 静脉-动脉体外膜肺氧合护理标准化方案在复杂高危冠心病患者中的应用研究[J]. 中华护理杂志, 2026, 61(1): 63-69.

GUO Enhui, LANG Qiuyan, WEN Hanchun, GAN Yanmei, WANG Shulin, LI Gaoye. Study on the application of a standardized nursing protocol for venous-arterial extracorporeal membrane oxygenation in patients with complex high-risk coronary heart disease[J]. Chinese Journal of Nursing, 2026, 61(1): 63-69.

图/表 2

参考文献 29

[1]	Tyczynski M, Kern A, Buller P, et al. Clinical outcomes and prognostic factors in complex,high-risk indicated procedure(CHIP) and high-bleeding-risk(HBR) patients undergoing per-cutaneous coronary intervention with sirolimus-eluting stent implantation:4-year results[J]. J Clin Med, 2023, 12(16):5313. DOI URL
[2]	韩雅玲. 复杂高危冠状动脉病变介入治疗的现状与挑战[J]. 中华心血管病杂志, 2021, 49(8):750-753.
	Han YL. Current status and challenges of interventional thera-py for patients with complex high risk coronary artery disease[J]. Chin J Cardiol, 2021, 49(8):750-753. DOI PMID
[3]	龚艳君, 霍勇. 复杂高危冠状动脉疾病的介入治疗[J]. 中国心血管病研究, 2022, 20(3):193-195.
	Gong YJ, Huo Y. Percutaneous coronary intervention for com-plex higher risk coronary artery disease[J]. Chin J Cardiovasc Res, 2022, 20(3):193-195.
[4]	Kunkel KJ, Dabbagh MF, Zaidan M, et al. Mechanical cir-culatory support in high-risk percutaneous coronary intervention[J]. Interv Cardiol Clin, 2021, 10(2):207-219.
[5]	李莲, 王金宁, 陈臣侃, 等. 护士主导的移动体外膜肺氧合患者区域转运标准化流程的构建及应用[J]. 中华护理杂志, 2023, 58(17):2053-2058. DOI URL
	Li L, Wang JN, Chen CK, et al. Construction and application of standardized process for regional transport of mobile extracor-poreal membrane oxygenation patients led by nurses[J]. Chin J Nurs, 2023, 58(17):2053-2058.
[6]	赵亚杰, 鞠辉, 冯艺, 等. 体外膜肺氧合辅助高危冠心病患者介入治疗的研究进展[J]. 临床麻醉学杂志, 2020, 36(11):1136-1139.
	Zhao YJ, Ju H, Feng Y, et al. Research progress of extracor-poreal membrane oxygenation in assisting interventional therapy for high-risk patients with coronary heart disease[J]. J Clin Anesthe, 2020, 36(11):1136-1139.
[7]	辛晨, 郭小靖, 任师远, 等. 体外心肺复苏院内急救流程的优化及效果评价[J]. 中华护理杂志, 2021, 56(8):1138-1144. DOI URL
	Xin C, Guo XJ, Ren SY, et al. Optimization and effect evalua-tion of in-hospital emergency process for extracroporeal cardio-pulmonary resuscitation[J]. Chin J Nurs, 2021, 56(8):1138-1144.
[8]	Kirtane AJ, Doshi D, Leon MB, et al. Treatment of higher-risk patients with an indication for revascularization:evolution within the field of contemporary percutaneous coronary intervention[J]. Circulation, 2016, 134(5):422-431. DOI PMID
[9]	Lorusso R, Shekar K, Maclaren G, et al. ELSO interim guide-lines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients[J]. ASAIO J, 2021, 67(8):827-844. DOI URL
[10]	韦当, 王聪尧, 肖晓娟, 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志, 2013, 8(4):316-319.
	Wei D, Wang CY, Xiao XJ, et al. Interpretation of the tools of AGREE Ⅱ[J]. Chin J Evid Based Pediatr, 2013, 8(4):316-319.
[11]	胡雁, 郝玉芳. 循证护理学[M]. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[12]	戴伟英, 庄一渝. 动脉-静脉体外膜肺氧合治疗病人下肢缺血护理清单的设计及应用[J]. 护理研究, 2022, 36(8):1476-1479.
	Dai WY, Zhuang YY. Design and application of nursing checklist for lower extremity ischemia in patients treated with arterial-venous extracorporeal membrane oxygenation[J]. Chin Nurs Res, 2022, 36(8):1476-1479.
[13]	李敏, 詹庆元. 体外生命支持下超保护性肺通气的实施[J]. 中国实用内科杂志, 2024, 44(3):177-181.
	Li M, Zhan QY. Ultra-lung-protective ventilation strategies under extracorporeal life support[J]. Chin J Pract Intern Med, 2024, 44(3):177-181.
[14]	闵苏, 敖虎山. 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.
	Min S, Ao HS. 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.
[15]	钟宇辉. VA-ECMO支持下复杂高危冠心病患者介入治疗的有效性及安全性研究[D]. 南宁: 广西医科大学, 2022.
	Zhong YH. Efficacy and safety of venous-arterial extracorpo-real membrane oxygenation in complex high-risk and indica-ted patients undergoing percutaneous coronary intervention[D]. Nanning: Guangxi Medical University, 2022.
[16]	Rei U. Nurse-Physician Collaboration Scale:development and psychometric testing[J]. J Adv Nurs, 2009, 65(7):1497-1508. DOI URL
[17]	陈静, 张贤, 张振香, 等. 医护合作量表的汉化及信效度检验[J]. 中华护理杂志, 2014, 49(2):236-240.
	Chen J, Zhang X, Zhang ZX, et al. Reliability and validity of Chinese version of Nurse-Physician Collaboration Scale[J]. Chin J Nurs, 2014, 49(2):236-240.
[18]	史纪元, 刘倩, 韦帅芳, 等. 护理临床实践指南面临的机遇与挑战[J]. 协和医学杂志,2025:1-11.
	Shi JY, Liu Q, Wei SF, et al. Challenges and opportunities in nursing clinical practice guidelines[J]. Peking Union Med Col-lege J,2025:1-11.
[19]	古春英, 杨钊群. 标准化护理程序用于体外膜肺氧合术患者对手术效率的影响[J]. 医学理论与实践, 2020, 33(12):2031-2033.
	Gu CY, Yang ZQ. Effect of standardized nursing procedure on operation efficiency of patients undergoing extracorporeal membrane oxygenation[J]. J Med Theory Pract, 2020, 33(12):2031-2033.
[20]	童小英, 郑洋, 殷婷婷, 等. 多学科ECMO团队护理对重症心脏病ECMO应用患者的效果观察[J]. 心血管病防治知识, 2024, 14(8):124-127.
	Tong XY, Zheng Y, Yin TT, et al. Observation on the effect of multidisciplinary ECMO team nursing on patients with severe heart disease treated with ECMO[J]. Prev Treat Cardiovasc Dis, 2024, 14(8):124-127.
[21]	吕倩. TeamSTEPPS对胸外科手术团队合作与效率的影响研究[D]. 长沙: 中南大学, 2023.
	Lü Q. Effect of TeamSTEPPS on the coordination and efficie-ncy of thoracic surgery team[D]. Changsha: Central South Uni-versity, 2023.
[22]	国家卫生健康委员会. 体外膜肺氧合(ECMO)技术临床应用管理规范[EB/OL].(2020-09-14)[2025-08-01]. https://www.nhc.gov.cn/wjw/c100175/202009/5623ad50c4214578abf7aa-c20de06200/files/1644833605976_14183.pdf.
	National Health Commission. Clinical application management specification for extracorporeal membrane oxygenation(ECMO) technology[EB/OL].(2020-09-14)[2025-08-01]. https://www.nhc.gov.cn/wjw/c100175/202009/5623ad50c4214578abf7aa-c20de06200/files/1644833605976_14183.pdf.
[23]	梁江淑渊, 曾妃, 黄冰瑛, 等. 体外膜肺氧合支持下患者院内转运安全管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(12):1456-1461. DOI URL
	Liang JSY, Zeng F, Huang BY, et al. Evidence summary of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation[J]. Chin J Nurs, 2022, 57(12):1456-1461. DOI URL
[24]	程雷, 项丽君, 曹猛, 等. 医护标准化沟通下缺血性脑卒中介入术后患者镇痛镇静评估流程的临床应用研究[J]. 护理学报, 2025, 32(9):7-14.
	Cheng L, Xiang LJ, Cao M, et al. Effectiveness of analgesia and sedation assessment process following endovascular treat-ment for ischemic stroke under standardized communication between healthcare professionals[J]. J Nurs(China), 2025, 32(9):7-14.
[25]	徐俊杰, 徐承义, 刘成伟, 等. 经皮穿刺插管建立体外膜肺氧合应用于高危经皮冠状动脉介入治疗患者的安全性和有效性[J]. 中国介入心脏病学杂志, 2025, 33(3):128-134.
	Xu JJ, Xu CY, Liu CW, et al. Safety and efficacy of percu-taneous cannulation for extracorporeal membrane oxygenation in high-risk patients undergoing percutaneous coronary inter-vention[J]. Chin J Interv Cardiol, 2025, 33(3):128-134.
[26]	Jia D, Yang IX, Ling RR, et al. Vascular complications of ex-tracorporeal membrane oxygenation:a systematic review and meta-regression analysis[J]. Crit Care Med, 2020, 48(12):e1269-e1277.
[27]	熊文芳, 姚岚, 李丹凤, 等. ProGidel缝合与手动压迫止血在VA-ECMO中的疗效比较[J]. 实用休克杂志(中英文), 2023, 7(5):285-288.
	Xiong WF, Yao L, Li DF, et al. Comparison of ProGlide suture and manual compression hemostasis in VA-ECMO[J]. J Pract Shock, 2023, 7(5):285-288.
[28]	Heuts S, Makhoul M, Mansouri AN, et al. Defining and under-standing the “extra-corporeal membrane oxygenation gap” in the veno-venous configuration:timing and causes of death[J]. Artif Organs, 2022, 46(3):349-361. DOI URL
[29]	叶丽霞, 许烨, 李琴, 等. 护士主导的液体反应性监测方案对预防脓毒性休克患者液体积聚综合征的效果研究[J]. 中华护理杂志, 2025, 60(16):1959-1965. DOI URL
	Ye LX, Xu Y, Li Q, et al. Effect of a nurse-led fluid re-sponsiveness monitoring protocol in preventing fluid accumulation syndrome in patients with septic shock[J]. Chin J Nurs, 2025, 60(16):1959-1965.

静脉-动脉体外膜肺氧合护理标准化方案在复杂高危冠心病患者中的应用研究

Study on the application of a standardized nursing protocol for venous-arterial extracorporeal membrane oxygenation in patients with complex high-risk coronary heart disease

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 29

相关文章 15

编辑推荐

Metrics

[1]	姜珊, 郭彩霞, 郭立华, 赵媛媛, 肖蒙, 杨依玲, 魏春艳, 李硕, 刘殿媛, 尚志丽. 外周静脉留置针并发症风险管理系统的开发与应用[J]. 中华护理杂志, 2025, 60(8): 908-913.
[2]	盛婉婷, 王蕊, 赵玉晓, 戚鹏菲, 高祀龙, 冯娟, 吕伯瀚, 牛群, 王刚. 中等长度静脉导管不同尖端位置应用效果的Meta分析[J]. 中华护理杂志, 2025, 60(8): 990-997.
[3]	高川, 谢韵漪, 陈阳, 张雨萌, 张宇扬, 苏雅静, 蔡文清, 李庆印. 经皮冠状动脉介入治疗护理注册登记平台的构建[J]. 中华护理杂志, 2025, 60(6): 666-670.
[4]	李奇, 毛依阳, 段颖杰, 张凤云, 王旭. 1例类鼻疽感染患儿并发脓毒性休克的护理[J]. 中华护理杂志, 2025, 60(20): 2519-2522.
[5]	罗瑾梅, 余萌, 李庆印, 陈彩莲, 李辉环, 盛倩倩, 吴群艳. 1例急性心肌梗死伴频发电风暴患者的护理[J]. 中华护理杂志, 2025, 60(18): 2265-2269.
[6]	刘语琴, 霍桂霞, 李韶波, 李宇敏, 卢云鹏, 张子琛, 杜秋慧, 倪梦迪, 刘发荣, 贾红红. 2型糖尿病患者并发症恐惧现状及影响因素分析[J]. 中华护理杂志, 2025, 60(17): 2118-2123.
[7]	王金宁, 潘向滢, 陈臣侃, 金佳家, 李佳. 2例心肺移植患者术前体外膜肺氧合辅助下实施步行康复训练的护理[J]. 中华护理杂志, 2025, 60(17): 2137-2140.
[8]	卢婷, 韦洁静, 应燕萍, 麻玲霞, 陈小丽, 徐谊. 一针式与两针式皮下隧道法在肿瘤患者PICC置管中应用效果的比较研究[J]. 中华护理杂志, 2025, 60(13): 1558-1562.
[9]	陈阳, 王诗瑜, 高川, 蔡文清, 苏雅静, 张雨萌, 李庆印. 75岁以上经皮冠状动脉介入治疗术后患者衰弱现状及影响因素研究[J]. 中华护理杂志, 2025, 60(13): 1588-1594.
[10]	石海燕, 韩中彦, 马骁, 丁瑜, 聂丹, 张丽娟, 杨姗姗, 任爱霞, 马燕兰. 1 350名护士对《成人鼻肠管留置与维护》团体标准认知情况的调查研究[J]. 中华护理杂志, 2025, 60(13): 1617-1623.
[11]	王海翔, 朱雪芬, 冯世萍, 钱秀群. 9例肺移植患者围手术期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, 2025, 60(12): 1499-1503.
[12]	刘海婷, 王咏梅, 郑贝贝, 蔡丽丽, 叶林斌, 吴佳芸, 宁丽, 李益民, 陈为霞. 冠心病合并糖尿病患者药物素养自评量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(9): 1065-1071.
[13]	路平, 王晓杰, 郭海凌. 老年乳腺癌患者术前衰弱与术后短期并发症的相关性研究[J]. 中华护理杂志, 2024, 59(8): 916-921.
[14]	郭凡, 王敏, 顾肖, 周英凤, 蒋玲, 黄琴, 程念开, 陈怡雷. 俯卧位通气患者眼部并发症护理的最佳证据总结[J]. 中华护理杂志, 2024, 59(8): 987-995.
[15]	杨小惠, 刘畅, 于卫华, 陈炯煌, 盛婉婷, 曹秀珠, 曾旭芬, 金向红, 赵林芳. 不同长度外周静脉导管在减重手术患者围手术期的应用效果评价[J]. 中华护理杂志, 2024, 59(4): 401-407.