护理学报 ›› 2020, Vol. 27 ›› Issue (7): 55-57.doi: 10.16460/j.issn1008-9969.2020.07.055
4例顽固性室性心动过速患者行ECMO+心外膜射频消融的术中护理
王玉珊1, 陈健聪2, 付晓华1, 冷坷1, 何维娟1, Akindavyi Gael1
- 1.南方医科大学珠江医院,广东 广州 510282;
2.暨南大学附属第一医院,广东 广州 510630
摘要： 目的 总结4例顽固性室性心动过速患者在静脉-动脉体外肺膜氧合(VA-ECMO)辅助下行心包穿刺心外膜射频消融术的术中护理经验。方法 4例患者在心血管内科、ICU、麻醉科、介入手术室、护理等多学科团队协作下,术前制定周密的手术方案、应急预案和具体分工,由多学科团队联合提供手术全程监护,术中护理重点包括：注重术中的低体温、出血、溶血及灌注量变化、管道的管理、并发症的预防等问题,严密观察病情和配合手术,加强生命体征监测和出凝血监测,进行管道和穿刺口安全管理。结果 4例患者手术成功,术中未发生严重并发症,住院时间为（12.50±2.06）d。1例在术后当天出现心源性休克,及时以CRRT配合治疗后好转出院。结论 VA-ECMO能在术中提供血流动力学支持,提高手术成功率。术中护士与团队紧密配合,加强术中体温、出血/溶血、灌注量的监护,实施并发症的预见护理,可为手术提供安全保障。
中图分类号:
- R473.54
| [1] Palaniswamy C, Miller MA, Reddy VY, et al.Hemodynamic Support for Ventricular Tachycardia Ablation[J]. Card Electrophysiol Clin, 2017,9(1):141-152.DOI:10.1016/j.ccep.2016.10.011. [2] Sacher F, Tedrow UB, Field ME, et al.Ventricular Tachycardia Ablation: Evolution of Patients and Procedures Over 8 Years[J]. Circ Arrhythm Electrophysiol, 2008,1(3):153-161.DOI:10.1161/CIRCEP.108.769471. [3] Di Biase L, Santangeli P, Burkhardt DJ, et al.Endo-epicardial Homogenization of the Scar Versus Limited Substrate Ablation for the Treatment of Electrical Storms in Patients with Ischemic Cardiomyopathy[J]. J Am Coll Cardiol, 2012,60(2):132-141.DOI:10.1016/j.jacc.2012.03.044. [4] Kuhne M, Abrams G, Sarrazin JF, et al.Isolated Potentials and Pace-mapping as Guides for Ablation of Ventricular Tachycardia in Various Types of Nonischemic Cardiomyopathy[J]. J Cardiovasc Electrophysiol, 2010,21(9):1017-1023.DOI:10.1111/j.1540-8167.2010.01756.x. [5] Vergara P, Trevisi N, Ricco A, et al.Late Potentials Abolition as an Additional Technique for Reduction of Arrhythmia Recurrence in Scar Related Ventricular Tachycardia Ablation[J]. J Cardiovasc Electrophysiol, 2012,23(6):621-627.DOI:10.1111/j.1540-8167.2011.02246.x. [6] Chen CY, Tsai J, Hsu TY, et al.ECMO Used in a Refractory Ventricular Tachycardia and Ventricular Fibrillation Patient: A National Case-control Study[J]. Medicine (Baltimore), 2016,95(13):e3204.DOI:10.1097/MD.0000000000003204. [7] Baratto F,Pappalardo F,Oloriz T, et al.Extracorporeal Membrane Oxygenation for Hemodynamic Support of Ventricular Tachycardia Ablation[J]. Circ Arrhythm Electrophysiol, 2016,9(12).DOI:10.1161/CIRCEP.116.004492. [8] Aoyama N, Imai H, Kurosawa T, et al.Therapeutic Strategy Using Extracorporeal Life Support, Including Appropriate Indication, Management, Limitation and Timing of Switch To Ventricular Assist Device in Patients with Acute Myocardial Infarction[J]. J Artif Organs, 2014, 17(1):33-41. DOI:10.1007/s10047-013-0735-z. [9] Ostadal P, Mlcek M, Holy F, et al.Direct Comparison of Percutaneous Circulatory Support Systems in Specific Hemodynamic Conditions in a Porcine Model[J]. Circ Arrhythm Electrophysiol, 2012,5(6):1202-1206.DOI:10.1161/CIRCEP.112.973123. [10] 任长明,郭莉,郝静荣,等. 经心包心外膜射频消融治疗器质性室速并发症观察与护理[J]. 护理实践与研究, 2016,13(24):29-31. [11] 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. [12] 丁妍,黄贤珍. 急性广泛前壁心肌梗死并发心源性休克患者的护理[J]. 中华护理杂志, 2019,54(2):277-280. [13] 魏秀娟,邵艳玲. 肝素抗凝在ECMO支持患者中的监测与护理进展[J].当代护士(下旬刊),2018,25(5):31-33. [14] 崔勇丽,刘晋萍,龙村. 体外膜肺氧合支持治疗中的凝血与抗凝[J]. 中国体外循环杂志, 2010,8(1):54-57. [15] 朱钢杰,王宁夫. 体外膜肺氧合并发症的预防及处理[J]. 心脑血管病防治, 2013,13(3):225-228. [16] Chung ES, Lim C, Lee HY, et al.Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction[J]. Korean J Thorac Cardiovasc Surg, 2011,44(4):273-278.DOI:10.5090/kjtcs.2011.44.4.273. |
| [1] | 谢缤纷,张妙云,陈新梅. 5例心脏介入术致心脏压塞患者行心包开窗的术中护理[J]. 护理学报, 2014, (17): 45-46. |
|
||