Abstract:

To summarize the postoperative anticoagulation nursing practice of a patient with heart failure treated with ECMO,CRRT and the implantable left ventricular assist device. Key points of care were as following. To begin with,we assessed the anticoagulant risk of patients in advance,and set up an anticoagulant nursing team as needed,which adapts the multidisciplinary team care mode to take care of patients. Then,we made anticoagulation targets by stages and adjusted anticoagulation strategies dynamically. Next,we monitored coagulation function closely to guard against delayed bleeding,as well as implementing target blood pressure management and focusing on tissue perfusion. Doctors and nurses evaluated patients cooperatively to adjust pump flow speed timely. In the end,we enhanced the knowledge relative to disease of patient by Medical Decision-Making Sharing. Through careful nursing care and treatment,the patient recovered and was discharged after 59 days.

Key words: Extracorporeal Life Support, Heart Failure, Anticoagulation, Nursing Care

摘要：

总结1例体外膜肺氧合、连续性肾脏替代治疗及植入式左心室辅助装置联合治疗心力衰竭患者的术后抗凝护理实践。护理要点：预先评估患者抗凝风险,采用多学科团队照护模式,按需组建抗凝护理团队;分阶段制订抗凝目标,动态调整抗凝策略;严密监测凝血功能,警惕迟发性出血;实施目标血压管理,关注组织灌注;医护协同评估,及时调整泵流速度;医护患决策共享,强化健康教育。该患者经过精心治理与护理,术后第59天康复出院。

关键词: 体外生命支持, 心力衰竭, 抗凝, 护理