总结10例急性ST段抬高型心肌梗死并发心搏骤停患者行体外心肺复苏联合急诊经皮冠状动脉介入治疗的急救护理经验。针对疾病病程进展快、心搏骤停情况下建立体外膜肺氧合难度大、经皮冠状动脉介入治疗风险高、术后神经系统功能恢复差、循环不稳定等特点,采取组建多学科协作急救护理团队、精准实施心肺复苏术、配合医生快速实施体外膜肺氧合及经皮冠状动脉介入治疗、做好患者体温管理与神经功能监测、稳定体外心肺复苏后患者血流动力学等护理措施。10例患者中5例病情好转出院,3例因神经功能障碍和(或)合并多脏器功能衰竭放弃治疗出院,1例转上级医院行心脏移植治疗,1例死亡。
To summarize emergency care experience of 10 patients with acute ST-segment elevation myocardial infarction complicated by sudden cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation combined with the emergency percutaneous coronary intervention. In view of the characteristics such as the rapid progression of the disease,the difficulty of establishing extracorporeal membrane oxygenation in the case of sudden cardiac arrest,the high risk of percutaneous coronary intervention,the poor postoperative recovery of nervous system function,and the instability of circulation,the caring measures were adopted,including the establishment of a multidisciplinary collaborative emergency care team,precise implementation of cardiopulmonary resuscitation,cooperation with doctors for rapid implementation of extracorporeal membrane oxygenation and percutaneous coronary intervention,temperature management and neurological function monitoring,stabilization of patient hemodynamics after extracorporeal cardiopulmonary resuscitation. Among the 10 patients,five patients' conditions were improved and were discharged,three patients were discharged after giving up treatment due to neurological dysfunction and/or combined multiple organ failure,one patient was transferred to a higher-level hospital for heart transplantation,and one patient died.
[1] Virani SS,Alonso A,Benjamin EJ,et al.Heart disease and stroke statistics-2020 update:a report from the American Heart Asso-ciation[J]. Circulation,2020,141(9):e139-e596.
[2] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志,2019,47(10):766-783.
Cardiology Branch of Chinese Medical Association,Editorial Board of Chinese Journal of Cardiology. 2019 Chinese Society of Cardiology(CSC) guidelines for the diagnosis and management of patients with ST-segment elevation myocardial infarction[J]. Chin J Cardiol,2019,47(10):766-783.
[3] 吴颖,张励庭,冯力,等. 体外膜肺氧合联合急诊经皮冠状动脉介入治疗抢救急性心肌梗死后心脏骤停患者的临床疗效及其影响因素分析[J]. 中国循环杂志,2018,33(6):561-566.
Wu Y,Zhang LT,Feng L,et al.Effect of extra-corporeal membrane cxygenation combined with percutaneous coronary intervention on cardiac arrest patients due to acute myocardial infarction[J]. Chin Circ J,2018,33(6):561-566.
[4] 徐静,祝益民,王露平,等. 体外心肺复苏启动前因素对患者预后的影响[J]. 中华急诊医学杂志,2021,30(10):1192-1196.
Xu J,Zhu YM,Wang LP,et al.Influence of factors before initiation of extracorporeal cardiopulmonary resuscitation on the prognosis of patients[J]. Chin J Emerg Med,2021,30(10):1192-1196.
[5] Extracorporeal Life Support Organization. Extracorporeal Life Support Organization-ECMO and ECLS[EB/OL].(2020-06-12)[2021-02-18]. https://www.elso.org/Registry/Statistics.Aspx.
[6] 中华医学会急诊医学分会复苏学组,成人体外心肺复苏专家共识组. 成人体外心肺复苏专家共识[J]. 中华急诊医学杂志,2018,27(1):22-29.
Resuscitation Group of Emergency Medicine Branch of Chinese Medical Association,Expert Consensus Group of Adult Extracorporeal Cardiopulmonary Resuscitation. Expert consensus on adult cardiopulmonary resuscitation[J]. Chin J Emerg Med,2018,27(1):22-29.
[7] 李庆印,刘裕文,郝云霞,等. 急诊经皮冠状动脉介入治疗护理现状与思考[J]. 中华急危重症护理杂志,2021,2(1):32-36.
Li QY,Liu YW,Hao YX,et al.Nursing status and thinking of emergency percutaneous coronary intervention[J]. Chin J Emerg Crit Care Nurs,2021,2(1):32-36.