总结1例重度肺动脉高压患者多模式体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）下行肺移植手术的护理体会。针对该患者肺移植前因重度肺动脉高压应用ECMO治疗出现的并发症,采取静脉-动脉-静脉ECMO（veno-artery-venous ECMO,VAV-ECMO）辅助治疗。护理要点：VAV-ECMO切换护理,运行时的动态监测与护理,抗凝与出血的安全护理,VAV-ECMO的撤机护理。其中ECMO多模式切换的配合,以控制肺动脉压为导向的心肺康复护理是该案例的难点和关键点。患者在肺移植术后第2天成功撤除ECMO,术后第4天成功拔除气管插管,入院23 d后病情稳定出院。
To summarize the nursing experience of a patient with severe pulmonary hypertension undergoing lung transplantation under multimodal extracorporeal membrane oxygenation（ECMO）. For the complications of ECMO treatment for severe pulmonary hypertension before lung transplantation,veno-artery-venous ECMO（VAV-ECMO）was used as adjuvant therapy. Key points of nursing included VAV-ECMO switching nursing,dynamic monitoring and nursing during operation,safety nursing of anticoagulation and bleeding,weaning nursing of VAV-ECMO. Among them,the coordination of ECMO multi-mode switching and the cardiopulmonary rehabilitation nursing oriented to control pulmonary artery pressure were the difficulties and the key points of nursing. The ECMO was successfully removed on the second day of lung transplantation,and the endotracheal tube was successfully removed on the fourth day after surgery. The patient was discharged from hospital in a stable condition 23 days after admission.
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