黄慧卿++郭松圆+何德化++张雪好

[摘要] 目的 总结5例暴发性心肌炎患者联合应用体外膜肺氧合（ECMO）和主动脉内球囊反搏（IABP）的护理经验。方法 选择我科在2014年8月～2016年4月收治的联合应用ECMO和IABP的暴发性心肌炎患者5例。疾病初期通过严密的病情观察，迅速、有效开始ECMO和IABP辅助支持；在ECMO和IABP运行期间密切监测心率、血压、凝血功能等指标，并执行严格的液体管理和体外循环管路管理，及时观察和处理心律失常、低血压、肺出血及肢端循环障碍等各类并发症。 结果 本组5例患者中，4例经过ECMO和IABP辅助治疗后成功撤机，病情好转出院，死亡1例。 结论 ECMO和IABP作为有效的辅助措施，对暴发性心肌炎患者病情转复至关重要，临床上需不断总结其相关护理经验，提高护理水平，促进患者康复。

[关键词] 体外膜肺氧合；主动脉内球囊反搏；心肌炎；护理

[中图分类号] R473.5 [文献标识码] B [文章编号] 1673-9701（2016）26-0158-04

Care for patients of fulminant myocarditis with extracorporeal membrane oxygenation and intro-aortic balloon pump

HUANG Huiqing1 GUO Songyuan1 HE Dehua2 ZHANG Xuehao2

1.Department of GICU， the First Affiliated Hospital of Xiamen University， Xiamen 361003， China； 2.Department of Cardiology，the First Affiliated Hospital of Xiamen University， Xiamen 361003， China

[Abstract] Objective To summarize the nursing experience of five cases of fulminant myocarditis with extracorporeal membrane oxygenation（ECMO） and intro-aortic balloon pump（IABP）. Methods Five cases of fulminant myocarditis with ECMO and IABP were selected from August 2014 to April 2016. The patient's condition was closely observed and effective ECMO and IABP treatment were provided. Heart rate， blood pressure， and blood clotting function were closely monitored during the stage of ECMO and IABP treatment. Fluid management and cardiopulmonary bypass pipeline management were strictly enforced. All kinds of complications， such as arrhythmia， hypotension， pulmonary hemorrhage and limb circulatory disorders were timely observed and treated. Results Four in five patients with ECMO and IABP treatment improved and were discharged and one died. Conclusion ECMO and IABP were effective treatments and essential to patients with fulminant myocarditis. Related nursing experience were need to summarized to improve the level of care and promote the rehabilitation of patients.

[Key words] Extracorporeal membrane oxygenation； Intro-aortic balloon pump； Myocarditis； Care

暴发性心肌炎常见于柯萨奇病毒等感染后导致局灶性或弥漫性心肌间质炎性渗出，心肌纤维水肿、变性、坏死。病情在发病1～2 d内急剧进展恶化、出现急性充血性心力衰竭、心源性休克、肺水肿、严重心律失常或阿斯综合征[1]。由于其常见于青少年，且起病急骤、病情演变迅速及死亡率极高，及时有效的综合性抢救治疗尤其重要，其中又以心肺功能的维持更是重中之重。体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）是迄今为止最前沿的辅助治疗手段之一，其工作原理主要是将血液从静脉引出，通过膜肺进行氧气和二氧化碳交换后回到静脉（V-V模式）或动脉（V-A模式），从而替代心肺功能，起到有效的呼吸循环支持[2，3]，在现代心脏危重症患者救治中作用举足轻重[4]。……