ISSN 2097-6046（网络）
ISSN 2096-7446（印刷）
CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 >

2023 , Vol. 4 >Issue 5: 454 - 457

DOI: https://doi.org/10.3761/j.issn.2096-7446.2023.05.015

重症护理研究

红斑狼疮患者体外膜肺氧合期间凝血异常的抗凝护理

  • 何志丽 ,
  • 卫政登 ,
  • 王巧金 ,
  • 白利平 ,
  • 高明榕
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  • 510055 广州市 中山大学附属第一医院重症医学科
何志丽：女,本科（硕士在读）,主管护师,E-mail：hezhli@mail.sysu.edu.cn

收稿日期: 2022-11-17

  网络出版日期: 2023-05-10

收起

Anticoagulation nursing of abnormal coagulation during extracorporeal model pulmonary oxygenation in a patient with systemic lupus erythematosus

  • HE Zhili ,
  • WEI Zhengdeng ,
  • WANG Qiaojin ,
  • BAI Liping ,
  • GAO Mingrong
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Received date: 2022-11-17

  Online published: 2023-05-10

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摘要

总结1例红斑狼疮合并心脏压塞患者在体外膜肺氧合期间凝血异常的护理体会。护理要点：联合多学科医护团队评估抗凝风险、制订抗凝方案;组建ECMO抗凝护理小组,制订抗凝护理评估单及流程,监测抗凝效果;将预防血栓形成及下肢缺血的评估及护理贯穿于治疗全过程。经过17 d的治疗及护理,患者病情稳定转回病房。

关键词： 红斑狼疮; 系统性; 体外膜肺氧合; 抗凝; 危重病护理

本文引用格式

何志丽 , 卫政登 , 王巧金 , 白利平 , 高明榕 . 红斑狼疮患者体外膜肺氧合期间凝血异常的抗凝护理[J]. 中华急危重症护理杂志, 2023 , 4(5) : 454 -457 . DOI: 10.3761/j.issn.2096-7446.2023.05.015

Abstract

To summarize the experience of abnormal coagulation during extracorporeal membrane oxygenation in a patient with systemic lupus erythematosus complicated with pericardial tamponade. A multidisciplinary health care team was involved in the evaluation of anticoagulation risks and the formulation of anticoagulation protocols. An ECMO anticoagulant care team was set up to develop related anticoagulant nursing evaluation lists and procedures,monitor the anticoagulant effect. The evaluation and nursing of preventing thrombosis and lower limb ischemia were carried out throughout the whole process of treatment. After 17 d of treatment and nursing,the patient was stable and transferred back to the ward.

Key words： Lupus Erythematosus; Systemic; Extracorporeal Membrane Oxygenation; Anticoagulation; Critical Care Nursing

参考文献

[1] 花迎杰,刘利鹏,边琳. 系统性红斑狼疮合并低凝血酶原血症-狼疮抗凝物综合征一例[J]. 中华医学杂志,2018,98(8):633.
Hua YJ,Liu LP,Bian L.A case of systemic lupus erythematosus complicated with hypoproteinemia-lupus anticoagulant syndrome[J]. Natl Med J China,2018,98(8):633.
[2] Appleton C,Gillam L,Koulogiannis K.Cardiac tamponade[J]. Cardiol Clin,2017,35(4):525-537.
[3] Chaves RCF,Rabello Filho R,Timenetsky KT,et al.Extracor-poreal membrane oxygenation:a literature review[J]. Rev Bras Ter Intensiva,2019,31(3):410-424.
[4] McMichael ABV,Ryerson LM,Ratano D,et al. 2021 ELSO adult and pediatric anticoagulation guidelines[J]. ASAIO J,2022,68(3):303-310.
[5] Sanfilippo F,Currò JM,la Via L,et al. Use of nafamostat mesilate for anticoagulation during extracorporeal membrane oxygenation:a systematic review[J]. Artif Organs,2022,46(12):2371-2381.
[6] 刘志艳,向倩,崔一民. 甲磺酸萘莫司他临床应用的研究现状[J]. 中国临床药理学杂志,2020,36(15):2368-2372.
Liu ZY,Xiang Q,Cui YM.Research status of clinical application of nafamostatmesilate[J]. Chin J Clin Pharmacol,2020,36(15):2368-2372.
[7] Davenport A.What are the anticoagulation options for intermittent hemodialysis?[J]. Nat Rev Nephrol,2011,7(9):499-508.
[8] Marasco SF,Lukas G,McDonald M,et al. Review of ECMO (extra corporeal membrane oxygenation）support in critically ill adult patients[J]. Heart Lung Circ,2008,17(Suppl 4):S41-S47.
[9] Lang YH,Zheng Y,Qi BC,et al.Anticoagulation with nafamostat mesilate during extracorporeal life support[J]. Int J Cardiol,2022,366:71-79.
[10] Esper SA,Levy JH,Waters JH,et al.Extracorporeal membrane oxygenation in the adult:a review of anticoagulation monitoring and transfusion[J]. Anesth Analg,2014,118(4):731-743.
[11] 司向,管向东. 体外膜肺氧合抗凝管理现状和挑战[J]. 中华医学杂志,2022,102(25):1864-1869.
Si X,Guan XD.Current status and challenges of anticoagulation management in extracorporeal membrane oxygenation[J]. Natl Med J China,2022,102(25):1864-1869.
[12] Liu Y,Yuan ZY,Han XN,et al.A comparison of activated par-tial thromboplastin time and activated coagulation time for anticoagulation monitoring during extracorporeal membrane oxygenation therapy[J]. Hamostaseologie,2022:1-8.
[13] 吕芳芳,殷静静,杨丽娟. 肺切除术后胸腔引流管管理的最佳证据总结[J]. 中华护理杂志,2020,55(5):773-779.
Lü FF,Yin JJ,Yang LJ.Summary of the best evidence for nursing management of thoracic drainage tube after pneumonectomy[J]. Chin J Nurs,2020,55(5):773-779.
[14] 王宁夫. 体外膜氧合器使用中严重并发症的防治[J]. 中华心血管病杂志,2020,48(6):431-433.
Wang NF.Prevention and intervention of major complications during application of extracorporeal membrane oxygenation[J]. Chin J Cardiol,2020,48(6):431-433.
[15] 吴月,徐胜玲,吴华堂. 1例ECMO技术抢救新型冠状病毒肺炎合并感染性休克老年病人的护理[J]. 护理研究,2020,34(7):1130-1133.
Wu Y,Xu SL,Wu HT.Nursing care of a patient with COVID-19 complicated with septic shock treated with ECMO[J]. Chin Nurs Res,2020,34(7):1130-1133.
[16] 罗小龙,黄亮,李洋. 清醒状态下体外膜肺氧合治疗的研究进展[J]. 中华急诊医学杂志,2020,29(7):1007-1010.
Luo XL,Huang L,Li Y.Research progress of extracorporeal membrane oxygenation in awake state[J]. Chin J Emerg Med,2020,29(7):1007-1010.
[17] 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 CPR. Expert consensus on adult cardiopulmonary resuscitation[J]. Chin J Emerg Med,2018,27(1):22-29.
[18] 廉波,陈彧,赵舟,等. 插管策略对静-动脉体外膜式氧合相关并发症的影响:单中心回顾性研究[J]. 中国循环杂志,2018, 33(4):380-384.
Lian B,Chen Y,Zhao Z,et al.Impact of cannulation strategies on veno-arterial extracorporeal membrane oxygenation complications—a single center retrospective study[J]. Chin Circ J,2018,33(4):380-384.
[19] Chanan EL,Bingham N,Smith DE,et al.Early detection,prevention,and management of acute limb ischemia in adults supported with venoarterial extracorporeal membrane oxygenation[J]. J Cardiothorac Vasc Anesth,2020,34(11):3125-3132.
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