总结1例体外膜肺氧合支持下行右肺动脉矫治术的术后护理体会。针对患儿病情进展迅速、循环不稳定及极易发生肺动脉高压危象、出血、血栓等问题,采取床边紧急建立体外膜肺氧合、严密监测左心功能、调整体位平衡双侧肺血流量、早期识别出血征象及积极预防血栓发生等措施。经过33 d治疗和护理,患儿病情稳定出院,出院后随访1年,患儿状况良好,生长发育正常。
To summarize the postoperative nursing experience of a case of right pulmonary artery correction supported by extracorporeal membrane oxygenation. In view of the rapid progress of the patient's condition,unstable circulation and being prone to pulmonary arterial hypertension crisis,bleeding and thrombosis,measures included emergent establishment of extracorporeal membrane oxygenation at the bedside,close monitoring of left heart function,adjustment of body position and balance of bilateral pulmonary blood flow,early identification of bleeding signs and active prevention of thrombosis. After 33 days of treatment and nursing,the child was discharged in stable condition. After one year of follow-up,the child was in good condition with normal growth and development.
[1] 李云平. 右肺动脉异常起源于升主动脉的术后护理[J]. 中国循环杂志,2014,29(S1):208.
Li YP.Postoperative nursing care of abnormal right pulmonary artery originating from ascending aorta[J]. Chin Circ J,2014, 29(S1):208.
[2] Gupta A,VanLoozen D,Polimenakos AC,et al. Restoring fetal circulation as a means of bridging treatment prior to surgical repair of anomalous origin of the right pulmonary artery from the ascending aorta with persistent pulmonary hypertension of the newborn[J]. Pediatr Cardiol,2018,39(4):848-851.
[3] 邹晨,张泽伟,杨丽君,等. 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[J]. 中华护理杂志,2021,56(1):120-123.
Zou C,Zhang ZW,Yang LJ,et al.Nursing cooperation in a case of extracorporeal membrane oxygenation assisted off-pump coronary unroofing surgery in children[J]. Chin J Nurs,2021, 56(1):120-123.
[4] Abraham BP,Gilliam E,Kim DW,et al.Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival[J]. Catheter Cardiovasc Interv,2016,88(4):592-599.
[5] 高月英,申蕊娟,苏琳. 《静脉治疗护理技术操作规范》的解读与临床实践[J]. 护理研究,2014,28(33):4179-4180.
Gao YY,Shen RJ,Su L.Interpretation and clinical practice of “intravenous treatment nursing technical operation specification”[J]. Chin Nurs Res,2014,28(33):4179-4180.
[6] 诸纪华,金陈娣,唐晓敏,等. 完全型大动脉转位术后低心排血量综合征患儿的护理[J]. 中华急危重症护理杂志,2021,2(3):283-285.
Zhu JH,Jin CD,Tang XM,et al.Nursing care of children with low cardiac output syndrome after complete transposition of great arteries[J]. Chin J Emerg Crit Care Nurs,2021,2(3):283-285.
[7] 胡亚玲,兰美娟,汪春海,等. 左心室辅助装置与体外膜肺氧合治疗1例心力衰竭患者的护理[J]. 中华护理杂志,2021,56(11):1707-1710.
Hu YL,Lan MJ,Wang CH,et al.Postoperative nursing care of a patient with heart failure treated by left ventricular assist device combined with central extracorporeal membrane oxygenation[J]. Chin J Nurs,2021,56(11):1707-1710.
[8] Ranger M,Johnston CC,Limperopoulos C,et al.Cerebral near-infrared spectroscopy as a measure of nociceptive evoked ac-tivity in critically ill infants[J]. Pain Res Manag,2011,16(5):331-336.
