Nursing care of a pregnant woman with primary mediastinal large B-cell lymphoma complicated with airway stenosis

doi:10.3761/j.issn.0254-1769.2023.05.013

Abstract

Abstract:

To summarize the nursing experience of a pregnant woman with primary mediastinal large B-cell lymphoma complicated with atmospheric tract stenosis. Nursing key points include inventory management to ensure the safety of ECMO two-way transport；setting up an exclusive nursing team to ensure the continuity of nursing process and effective implementation of decision-making；staged coagulation monitoring and management during ECMO and CRRT operation；doctor-nurse cooperation was carried out according to the patient’s condition to predict the related complications and formulate the process plan，to provide a safe guarantee for the prevention of airway obstruction，tumor lysis syndrome，catheter-related bloodstream infection and other related complications. At the same time，patients are provided with refined pregnancy management and individualized psychological intervention. The patient was hospitalized for 9 days. After careful treatment and nursing，the patient’s condition was and improved transferred to the department of obstetrics for further treatment.

Key words: Lymphoma, Extracorporeal Membrane Oxygenation, Pregnant Woman, Airway Stenosis, Obstetrical Nursing

摘要：

总结1例原发纵隔大B细胞淋巴瘤并发大气道狭窄孕产妇的护理经验。护理要点包括使用体外膜肺氧合转运清单，保障双向转运安全；成立专属护理团队，保证护理过程的连贯性；未抗凝与抗凝状态下多渠道出凝血的监测与护理；严重并发症的预防与护理；实施精细化的妊娠期管理及个体化心理护理。患者在呼吸与危重症医学科住院9 d，经过精心的治疗及护理，病情好转，后转至产科继续治疗。

关键词: 淋巴瘤, 体外膜肺氧合, 孕妇, 大气道狭窄, 产科护理

ZHANG Yu, ZHANG Chunyan, WU Haiyan, WANG Shuqin, JIA Yanrui, SUN Bing. Nursing care of a pregnant woman with primary mediastinal large B-cell lymphoma complicated with airway stenosis[J]. Chinese Journal of Nursing, 2023, 58(5): 600-604.

张煜, 张春艳, 吴海燕, 王淑芹, 贾燕瑞, 孙兵. 1例原发纵隔大B细胞淋巴瘤并发大气道狭窄孕产妇的护理[J]. 中华护理杂志, 2023, 58(5): 600-604.

References 16

[1]	张欣. 原发纵膈大B细胞淋巴瘤36例临床分析[D]. 青岛: 青岛大学, 2018.
	Zhang X. Clinical analysis of 36 cases of primary mediastinal B-cell lymphoma[D]. Qingdao: Qingdao University, 2018.
[2]	Mottok A, Wright G, Rosenwald A, et al. Molecular classification of primary mediastinal large B-cell lymphoma using routinely available tissue specimens[J]. Blood, 2018, 132(22):2401-2405. DOI PMID
[3]	Ahmed Z, Afridi SS, Shahid Z, et al. Primary mediastinal B-cell lymphoma:a 2021 update on genetics,diagnosis,and novel therapeutics[J]. Clin Lymphoma Myeloma Leuk,2021, 21(11):e865-e875. DOI URL
[4]	杨小锋, 梅劼. 妊娠合并原发性纵隔大B细胞淋巴瘤伴上腔静脉综合征1例报告[J]. 实用医院临床杂志, 2019, 16(6):248-249.
	Yang XF, Mei J. Pregnancy with primary mediastinal large B-cell lymphoma with superior vena cava syndrome:a case report[J]. Pract J Clin Med, 2019, 16(6):248-249.
[5]	刘志贞, 陈恩国, 闻胜兰, 等. 体外膜肺氧合支持下经纤维支气管镜介入治疗重度恶性肿瘤性气道狭窄3例[J]. 中华急诊医学杂志, 2016, 25(4):515-517.
	Liu ZZ, Chen EG, Wen SL, et al. Case report of using extracorporeal membrane oxygenation during high-risk interventional therapy by fibrobronchoscope on three patients with malignant tumor airway stenosis[J]. Chin J Emerg Med, 2016, 25(4): 515-517.
[6]	潘红, 黄琴红, 蔡英华, 等. 13例体外膜肺氧合治疗危重患者院内转运的护理[J]. 中华护理杂志, 2017, 52(5):561-563.
	Pan H, Huang QH, Cai YH, et al. Nursing care of 13 critically ill patients with extracorporeal membrane oxygenation for intra-hospital transfer[J]. Chin J Nurs, 2017, 52(5):561-563.
[7]	王淑芹, 张春艳, 万娜, 等. 体外膜肺氧合支持危重患者院内转运核查单的编制及应用[J]. 护理学杂志, 2019, 34(18):22-25.
	Wang SQ, Zhang CY, Wan N, et al. Development and application of a checklist for intra-hospital transport of the critically ill supported by extracorporeal membrane oxygenation[J]. J Nurs Sci, 2019, 34(18):22-25.
[8]	胡恩华, 庞志强, 尹炜, 等. 1例重症肺炎产妇行体外膜肺氧合联合俯卧位通气治疗的护理[J]. 护理学报, 2019, 26(11):68-70.
	Hu EH, Pang ZQ, Yin W, et al. Nursing care of a parturient with severe pneumonia undergoing extracorporeal membrane oxygenation combined with prone position ventilation[J]. J Nurs China, 2019, 26(11):68-70.
[9]	王淑芹, 万娜, 徐新, 等. 应用多种ECMO模式救治一例危重症甲型H1N1流感产妇的护理[J]. 中国急救复苏与灾害医学杂志, 2020, 15(11):1341-1344.
	Wang SQ, Wan N, Xu X, et al. Nursing care of a critically ill pregnant woman with influenza A(H1N1) treated by multiple ECMO modes[J]. China J Emerg Resusc Disaster Med, 2020, 15(11):1341-1344.
[10]	赵举, 崔勇丽, 刘刚. ECMO中的抗凝管理[J]. 中国急救医学, 2021, 41(7):607-609.
	Zhao J, Cui YL, Liu G. Anticoagulation management in ECMO[J]. Chin J Crit Care Med, 2021, 41(7):607-609.
[11]	谢王芳, 楼晓芳, 诸纪华, 等. 1例前纵隔淋巴瘤并发严重气道梗阻患儿的护理[J]. 中华护理杂志, 2021, 56(2):269-272. DOI
	Xie WF, Lou XF, Zhu JH, et al. Nursing care of a child with anterior mediastinal lymphoma complicated with severe airway obstruction[J]. Chin J Nurs, 2021, 56(2):269-272. DOI
[12]	Zivin SP, Elias Y, Ray CE Jr. Tumor lysis syndrome and primary hepatic malignancy:case presentation and review of the literature[J]. Semin Intervent Radiol, 2015, 32(1):3-9. DOI URL
[13]	张素兰, 王芳, 杨忻, 等. 9例急性肿瘤溶解综合征病人行连续性肾脏替代治疗的护理[J]. 护理研究, 2015, 29(9):1127-1129.
	Zhang SL, Wang F, Yang X, et al. Nursing care of 9 patients with acute tumor lysis syndrome undergoing continuous renal replacement therapy[J]. Chin Nurs Res, 2015, 29(9):1127-1129.
[14]	单瀚, 常莹莹, 朱斌. 长春新碱和长春地辛治疗弥漫性大B细胞淋巴瘤的临床评价[J]. 中国临床药学杂志, 2019, 28(1):4-8.
	Shan H, Chang YY, Zhu B. Clinical evaluation of vincristine and vindesine on the treatment of diffuse large B-cell lymphoma[J]. Chin J Clin Pharm, 2019, 28(1):4-8.
[15]	Infusion Nurses Society. 2021 infusion therapy standards of practice updates[J]. J Infus Nurs,2021, 44(4):189-190. DOI URL
[16]	韩遵海, 刘雪娇, 何茵, 等. ICU以患者家庭为中心探视模式的研究进展[J]. 中华护理杂志, 2019, 54(2):235-238. DOI
	Han ZH, Liu XJ, He Y, et al. Research progress of ICU patient-and family-centered care[J]. Chin J Nurs, 2019, 54(2): 235-238.