组合式体外膜肺氧合联合连续性血液净化治疗多器官功能衰竭患者的护理

目的探讨组合式体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)联合连续性血液净化(continuous blood purification,CBP)治疗多器官功能衰竭(multiple organ dysfunction syndrome,MODS)患者的护理方法。方法回顾性分析并总结2011年8月至2013年3月,南京军区南京总医院国家肾脏疾病临床医学研究中心重症监护病房收治的6例MODS患者的临床资料。结果 6例患者中发生高胆红素血症1例(16.7%),溶血2例(33.3%),消化道出血1例(16.7%),插管部位出血3例(50.0%);存活出院1例(16.7%),放弃治疗4例(66.7%),病死1例(16.7%)。结论 ECMO联合CBP治疗MODS患者,有利于避免重要脏器的不可逆损伤,而容量管理、管道维护、血流动力学监测、出凝血指标观察及并发症的预防处理是患者成功救护的重要环节。

Nursing of Combined Joint ECMO Continuous Blood Purification Therapy for Patients with Mul-tiple Organ Dysfunction Syndrome

Objective To discuss the nursing method of extracorporeal membrane oxygenation （ECMO） combined continuous blood purification （CBP）in the treatment of patients with multiple organ dysfunction syndrome （MODS）.Methods Clinical data of 6 cases of MODS patients in our department from August 201 1 to March 2013 were analyzed retrospectively.Results There is one patient had hyperbilirubinemia （16.7%）,two cases of hemolysis （33.3%）,one case of gastrointestinal hemorrhage （16.7%）,3 cases of cannulation site bleeding （50.0%）;one cases discharged （1 6.7%）,giving up 4 patients （66.7%）and 1 pa-tient died （16.7%）.Conclusion ECMO therapy combined CBP in the treatment of MODS patients can a-void irreversible damage to vital organs,and capacity management,pipeline maintenance,hemodynamic mo-nitoring,the prevention and treatment of complications of coagulation parameters observed in patients are an important part of a successful rescue.