心脏移植术后体外膜肺氧合支持治疗的监护

总结了10例心脏移植术后应用体外膜肺氧合(ECMO)支持治疗的护理经验。10例心脏移植术后出现急性供心衰竭行ECMO辅助治疗,术后监测心电图、血流动力学变化、体温、尿量、引流液、活化凝血时间(ACT)、肝肾功能、游离血红蛋白、胶渗压情况。9例痊愈出院,病死1例,ECMO辅助时间40-824h,床旁超声心动图(UCG)评价心功能得到恢复,移植术后ECMO辅助100h顺利撤除,远期随访结果满意。ECMO支持治疗期间加强心肺功能监护,合理调整呼吸机参数,加强肺部及呼吸道护理,加强心律失常、出血、栓塞、感染、压疮等并发症的防治,可明显降低心脏移植术后危重症患者的病死率。

Nursing care of patients with extracorporeal membrane oxygenation for postoperative support in heart transplantation

This paper summarizes the nursing care of patients with extracorporeal membrane oxygenation (ECMO) for postoperative support in heart transplantation. Ten patients suffered from acute graft failure after heart transplantation and applied the extracorporeal membrane oxygenation for postoperative support. All the patients were monitored on electrocardiogram, hemodynamics, body temperature, urine volume, drainage volume, activated coagulation time, liver and renal function, free hemoglobin and colloid osmotic pressure. Nine survivals were discharged with recovery and one patient died. The duration of ECMO support ranged from 40 to 824 hours. When the heart function showed recovered based on bedside UCG. the ECMO could be weaned off uneventfully after 100 hours and the long-term clinical outcomes were good. It is suggested that close monitoring of heart & lung function during ECMO support, proper adjustment of ventilator index, intensive lung & respiratory tract care, prevention of arrhythmia, bleeding, embolism, infections, bedsores and other complications may decrease the mortality of severe patients with heart transplantation.