长时程体外膜肺氧合的护理管理实践及启示
Nursing practice and inspiration of Prolonged Extracorporeal Membrane Oxygenation
罗红波 1孙建华 2黄莉 3谢铃莉 2赵明曦 1李尊柱 1井杰 1李鑫 1马鸿鸣 1孙红4
作者信息
- 1. 中国医学科学院北京协和医院重症医学科,100730 北京市
- 2. 中国医学科学院北京协和医院内科ICU,100730 北京市
- 3. 中国医学科学院北京协和医学院护理学院
- 4. 中国医学科学院北京协和医院组织处(统战处),100730 北京市
- 折叠
摘要
目的:总结重症患者接受长时程体外膜肺氧合治疗的护理管理要点,为提升长时程体外膜肺氧合治疗效果,改善患者预后提供参考.方法:对14例接受长时程体外膜肺氧合治疗的重症患者开展以护士为核心的综合性护理管理,核心要素包括基础管理、呼吸康复管理、多设备管理及院内转运管理.观察患者疾病转归情况.结果:14 例接受长时程体外膜肺氧合治疗的重症患者体外膜肺氧合持续时间为14～87 [29.00(22.75,36.00)]天,3 例患者发生下肢深静脉血栓,2 例患者发生呼吸机相关性肺炎,未发生导管相关性血流感染、尿管相关性尿路感染等.最终8例患者成功撤机,6 例患者撤机后成功存活.结论:长时程体外膜肺氧合护理管理策略从患者实际情况出发,进行全方位、全流程护理干预,有利于降低患者不良事件发生风险,提升护理质量,进而提高患者撤机成功率与撤机后存活率,改善患者预后.
Abstract
Objective:To summarize the nursing points of critically ill patients receiving Prolonged Extracorporeal Membrane Oxygenation(P-ECMO)therapy,so as to provide reference for clinical nursing.Methods:Comprehensive nursing management were provided to the 14 critically ill patients with P-ECMO therapy.The core elements of P-ECMO nursing included basic management,respiratory rehabilitation management,equipment management and inter-hospital transport management.Results:After timely treatment and comprehensive nursing intervention,the duration of extracorporeal membrane oxygenation treatment was 14-87[29.00(22.75,36.00)]days.Three patients developed deep venous thrombosis,while two patients developed ventilator-associated pneumonia.The incidence of catheter-associated bloodstream infection and catheter-associated urinary tract infection was zero.In the end,8 patients were successfully removed from the machine,and 6 patients survived successfully.Conclusion:Based on the actual situation of patients,the P-ECMO nursing management strategy carries out all-round and whole-process nursing intervention,which is conducive to reducing the risk of complications of patients,improving the success rate and survival rate of patients after withdrawal,and improving the prognosis of patients.
关键词
长时程体外膜肺氧合/重症监护/护理质量Key words
Prolonged Extracorporeal Membrane Oxygenation/intensive care/nursing quality引用本文复制引用
基金项目
北京协和医院中央高水平医院临床科研专项专科提升计划(2022-PUMCH-B-126)
出版年
2024
NETL
NSTL
万方数据