体外膜肺支持下肺移植的护理

目的探讨应用体外膜肺氧合（ECMO）支持下肺移植的护理方案,提高肺移植的成功率。方法总结29例在ECOM支持下进行肺移植患者护理经验。结果所有患者ECMO撤除2h后,供氧良好,没有发生与ECMO有关的严重并发症;15例术后即刻撤除ECMO支持。结论针对性护理方案能及时发现并处理ECMO支持下肺移植术后出现的问题,可以满足ECMO支持下肺移植术的护理需要。     

应用体外膜肺氧合治疗心脏术后低心排的观察与护理

总结体外循环心脏手术后并发低心排的患者应用体外膜肺氧合(ECMO)支持治疗的经验和护理要点.回顾分析10例患者在体外循环心脏手术后并发低心排应用ECMO救治时的护理措施,通过实施严格的病房管理、严密的血流动力学及灌注流量的监测、严防并发症的发生等一系列护理措施.10例病例ECMO辅助时间4～124.5 h,平均38 h,其中8例顺利撤离ECMO,1例死亡,1例放弃治疗.对于体外循环心脏术后并发低心排的患者应用ECMO支持为患者提供最快的心肺功能支持,也为抢救赢得了时机,严密的监测和有效的护理是保证ECMO治疗成功的关键.     

基于VA-ECMO支持下1例危重症患者远程转运护理

目的:探讨基于体外膜肺氧合(ECMO)支持下危重症患者院际转运的护理经验,指出ECMO转运过程中的不足,并提出改进措施。方法:在转运前评估病情、仪器设备准备、ECMO转运团队人员配置及团队分工与协作;转运过程中严密监测患者基础生命体征和ECMO系统参数;对突发情况做出正确应急处理;在目的地到达后完成安全交接。结果:对1例危重症患者成功施行ECMO支持下长途转运,转运距离160 km,转运使用时间120 min。结论:在ECMO支持和专业护理下,危重症患者能够实现安全、长途转运,可显著提升危重患者的抢救效率和成功率,然而需进一步改进设备、规范操作及经验积累,实现技术全面成熟且在基层医院广泛推广和应用。     

ECMO辅助肺移植围术期的护理配合

目的总结体外膜肺氧合(ECMO)辅助肺移植手术的护理配合经验。方法对45例终末期肺病伴肺动脉高压的患者进行充分的术前准备,在肺移植术中应用了ECMO辅助转流,其中单肺移植21例,双肺移植24例。所有患者行右侧股动静脉置管ECMO辅助转流。转流期间维持激活凝血时间(ACT)160～200s,ECMO流量控制在1.8～2.5L/(m2.min)。术中严密细致地做好各项监测及护理配合。受者术后在氧合和血流动力学平稳后撤除ECMO。结果所有受者手术过程顺利,41例在移植术后顺利撤除ECMO;4例术后继续使用ECMO支持。结论ECMO可安全有效地用于肺移植术中的呼吸循环辅助,提高肺移植手术的成功率。充分的术前准备、术中全面的监测、娴熟的手术配合和合理的供肺保存是手术成功的关键因素之一,台上、台下严格的无菌技术操作,消毒隔离制度的管理是手术成功的保证。     

体外膜肺氧合辅助肺移植手术的护理配合

目的探讨体外膜肺氧合(ECMO)辅助肺移植手术的护理配合措施。方法回顾总结45例终末期肺病伴肺动脉高压的患者在ECMO辅助转流下行肺移植术的手术配合措施。结果所有患者手术过程顺利,41例术毕24 h内顺利撤除ECMO,另4例术后继续使用ECMO支持。结论 ECMO是肺移植围术期支持的有效手段,可提高肺移植手术的成功率,手术室护士正确、熟练、高质量的手术配合对手术成功起着重要作用。     

1例双肺序贯移植术后应用体外膜肺氧合技术的护理

目的 总结1例同种异体双肺序贯移植术后应用体外膜肺氧合技术(ECMO)应用的护理经验.方法 对1例32岁男性患者施行双肺序贯移植术,手术中因血流动力学不稳定紧急建立体外循环(CPB),并在术后转为体外膜肺氧合(ECMO).结果 术后7 d中患者在ECMO支持下可以维持较理想的实验室检查结果,但终因左主支气管吻合口瘘和多器官功能障碍综合征(MODS)于术后第9天死亡.结论 ECMO作为肺移植术后呼吸支持,可以较好地控制移植后双肺的再灌注,有效改善术后肺功能.     

1例双肺序贯移植术后应用体外膜肺氧合技术的护理

目的总结1例同种异体双肺序贯移植术后应用体外膜肺氧合技术(ECMO)应用的护理经验。方法对1例32岁男性患者施行双肺序贯移植术,手术中因血流动力学不稳定紧急建立体外循环(CPB),并在术后转为体外膜肺氧合(ECMO)。结果术后7d中患者在ECMO支持下可以维持较理想的实验室检查结果,但终因左主支气管吻合口瘘和多器官功能障碍综合征(MODS)于术后第9天死亡。结论ECMO作为肺移植术后呼吸支持,可以较好地控制移植后双肺的再灌注,有效改善术后肺功能。     

1例VA-ECMO支持下TAVR治疗高危主动脉瓣重度狭窄合并心肺衰竭患者的护理报道

本文通过报道1例动脉-静脉体外膜肺氧合（Arterio-venous extracorporeal membranous oxygenator,VA-ECMO）支持下经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)治疗心肺功能不全高危主动脉瓣重度狭窄患者的护理经验,详细描述了病例诊疗经过、病例病情监测和评估、ECMO支持下的转运、呼吸机及气管切开的护理、ECMO支持期间的注意事项、TAVR术后并发症的管理及术后康复方案,经过2月余精心治疗,患者康复出院。     

终末期肺病患者肺移植术后ICU内的护理

目的 总结24例终末期肺病患者肺移植术后ICU内的护理经验。方法 收集2020年6月-2022年2月本中心24例终末期肺病行肺移植术后患者ICU内的临床资料,对患者术后体外膜肺氧合(ECMO)对心肺功能桥接支持的护理、心肺适应期循环管理的护理配合、移植肺正压通气呼吸支持策略及肺移植术后患者症状群护理要点进行分析总结。结果 24例肺移植患者中,18例患者预后良好,3例患者术后发生并发症长期住院治疗,围手术期(术后30 d内)死亡1例,术后30 d以上因并发症死亡2例。结论 在终末期肺病患者肺移植术后ICU内的护理过程中,积极开展以护士为主导的多学科团队合作管理,尤其注意密切监测患者心肺功能,并及时反馈给医疗团队,做好ECMO备用机的管理以及紧急床旁调整ECMO模式的配合工作,关注患者心肺适应期特殊循环状态的护理要点,熟悉移植肺的特点及正压通气呼吸支持策略,通过监测和不断调整为患者提供最佳的呼吸支持,同时及时评估患者可能出现的症状群并予以干预,对患者的预后至关重要。     

血浆置换疗法联合ECMO（体外膜肺氧合）成功救治重症暴发性心肌炎1例护理体会

【】 目的 总结应用血浆置换(plasma exchange,PE)联合体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)成功救治一例重症暴发性心肌炎全心功能衰竭患者的护理体会。方法 对患者给予抗病毒、营养心肌、机械通气、激素冲击、利尿、输血等对症支持治疗基础上,应用PE联合ECMO治疗。结果 患者使用ECMO辅助支持7d后,心功能逐步恢复正常,病情好转出院。结论 ECMO是一种有效的生命支持方法,PE联合ECMO可有效改善重症暴发性心肌炎患者心功能,降低患者体内抗体水平,改善患者的临床症状和预后;完善的监护技术和优质的专科护理是提高治疗效果、减少并发症,使联合治疗得以顺利实施的关键。     

1例体外膜肺氧合辅助行介入治疗心肌梗死合并心力衰竭的护理

目的 评价心肌梗死合并心力衰竭在体外膜肺氧合（ECMO）辅助下行介入治疗时,导管室介入护理要点和配合.方法 对心肌梗死合并心力衰竭,不能耐受介入治疗的1例老年患者,同时应用ECMO给予循环呼吸支持后行冠状动脉介入治疗,做好术前、术中护理.结果 在医护合力精心救治下,通过ECMO辅助后,患者血流动力学较前稳定,术中患者心功能耐受PCI治疗,造影提示左冠状动脉狭窄成功植入支架,送回病房进一步治疗.结论 ECMO可对心力衰竭及射血分数低的患者起到生命支持的作用,导管室护士在配合手术中,做好充分的准备是手术成功的必要保证,术中注意患者的保温、保暖,预防由于冷刺激造成术后发热是重要的护理措施.     

1例体外膜肺氧合辅助非体外循环下患儿行冠状动脉去顶手术的护理配合

总结1例体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）辅助非体外循环下患儿行冠状动脉去顶手术的护理配合经验。护理要点如下:术前病情讨论、手术间准备、ECMO下患儿的院内转运,术中护理配合和应急预案制订以及术后管理。该例患儿成功完成心脏手术,术后继续ECMO支持,14 d后顺利脱机,术后27 d出院。     

Impact of multiple organ system dysfunction and nosocomial infections on survival of children treated with extracorporeal membrane oxygenation after heart surgery

OBJECTIVES: To evaluate whether cardiac and noncardiac variables may be used to predict survival in children treated with extracorporeal membrane oxygenation (ECMO) after cardiopulmonary bypass and to determine when to discontinue ECMO support. DESIGN: Retrospective review. SETTING: Neonatal and pediatric intensive care units of Kosair Children's Hospital. PATIENTS: Fifty-nine children treated with ECMO after cardiopulmonary bypass from 1987 through 1996. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical, nursing, operative, and perfusion records for each patient were reviewed. The primary outcome measure was survival to hospital discharge. Cardiac and noncardiac variables were recorded at serial times. Nineteen of 59 patients (32%) survived. No cardiac variable was a clinically useful predictor of survival or marker for when to discontinue ECMO. Among the noncardiac variables, progressive multiple organ system dysfunction and development of a nosocomial infection were significantly associated with nonsurvival. No patient with a positive blood culture (n = 3) within the first 24 hrs of ECMO survived, and 21 of 24 children with a positive culture from any site during ECMO died (p = .007). Despite their higher mortality, children with positive cultures were supported with ECMO significantly longer than those with negative cultures (275+/-168 vs. 135+/-108 hrs, respectively; p = .0004). For all patients, the longest duration of ECMO that resulted in survival was 256 hrs. For children with a positive culture, the longest duration of support that resulted in survival was 200 hrs. CONCLUSIONS: Support with ECMO beyond 256 hrs was not associated with survival. Progressive multiple organ system dysfunction and nosocomial infections have a negative impact on survival. Serious consideration should be given to discontinuing ECMO support whenever there is a progressive increase in the number of abnormally functioning organ systems, a nosocomial infection occurs, or native cardiac function has not improved significantly by 250 hrs of ECMO support.     

Extracorporeal membrane oxygenation for pediatric respiratory failure: History,development and current status

Extracorporeal membrane oxygenation (ECMO) is currently used to support patients of all ages with acute severe respiratory failure non-responsive to conventional treatments, and although initial use was almost exclusively in neonates, use for this age group is decreasing while use in older children remains stable (300-500 cases annually) and support for adults is increasing. Recent advances in technology include: refinement of double lumen veno-venous (VV) cannulas to support a large range of patient size, pumps with lower prime volumes, more efficient oxygenators, changes in circuit configuration to decrease turbulent flow and hemolysis. Veno-arterial (VA) mode of support remains the predominant type used; however, VV support has lower risk of central nervous injury and mortality. Key to successful survival is implementation of ECMO before irreversible organ injury develops, unless support with ECMO is used as a bridge to transplant. Among pediatric patients treated with ECMO mortality varies by pulmonary diagnosis, underlying condition, other non-pulmonary organ dysfunction as well as patient age, but has remained relatively unchanged overall (43%) over the past several decades. Additional risk factors associated with death include prolonged use of mechanical ventilation (> 2 wk) prior to ECMO, use of VA ECMO, older patient age, prolonged ECMO support as well as complications during ECMO. Medical evidence regarding daily patient management specifically related to ECMO is scant, it usually mirrors care recommended for similar patients treated without ECMO. Linkage of the Extracorporeal Life Support Organization dataset with other databases and collaborative research networks will be required to address this knowledge deficit as most centers treat only a few pediatric respiratory failure patients each year.     

Extracorporeal membrane oxygenation: current use and future directions

Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed.     

危重症患儿体外膜肺氧合支持下长途转运的护理

总结34例危重症患儿体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）支持下长途转运的护理经验,包括制订转运计划,转运前物品、患儿准备及通知转入科室,转移至救护担架车、转移至急救车、转运途中患儿及ECMO管理,转运后患儿交接,并发症及意外情况的处理等。通过精心计划、团队合作和针对性护理管理,34例危重症患儿ECMO支持下长途转运均安全到达,无患儿病死,最终患儿脱机成功,康复出院。     

Extracorporeal membrane oxygenation rescue for critically ill children with cardiopulmonary failure北大核心CSCD

Objective To summarize the therapeutic effects of extracorporeal membrane oxygenation (ECMO) on critically ill children with severe cardiopulmonary failure. Methods The pediatric patients supported with ECMO admitted to pediatric intensive care unit (PICU) from December 2015 to August 2017 were enrolled in this study. The data of demographics of patients, diagnosis, indication for ECMO, the procedure of ECMO support, complications, and survival status were analyzed. Results A total of 17 pediatric patients including 9 male and 8 female with severe cardiopulmonary failure treated with ECMO were studied. The median of age was 24 (2, 117) months, and the median of body weight was 12 (5, 33) kg. The indications for initiation of ECMO were cardiovascular failure with poor response to conventional therapy and severe acute respiratory distress syndrome (ARDS) without any beneficial effect obtained from mechanical ventilation. The percutaneous cannulation was done under ultrasound guidance by a team of trained intensivists through right cervical vein and internal carotid artery resulting in veno-Arterial extracorporeal membrane oxygenation support. The mean duration of ECMO support was 212. 5 h with median 188. 5 (3-924) h. All patients were treated with mechanical ventilation for prevention from pulmonary atelectasis. Of 17 patients, 10 were coupled with continuous renal replacement therapy (CRRT) to keep fluid balance. As a result, 11 children (64. 7%) were successfully weaned from ECMO defined as survival for 24 h after ECMO, and 10 children (58. 8%) were alive to discharge from hospital. One of 2 cardiac arrest cases treated with extracorporeal cardiopulmonary resuscitation (ECPR) was alive. During ECMO support, there were 41 adverse events happened including pressure ulcers (64.7%), thrombocytopenia (52. 9%), bleeding (35. 3%) . Conclusions The survival rate at discharge was 58. 8% in pediatric patients with severe cardiopulinonaiy failure with poor response to conventional therapy. Our data suggest that ECMO support is an important rescue technique for pediatric critical illness.