Nursing experience of a patient with acute myocardial infarction complicated by cardiogenic shock treated with extracorporeal membrane oxygenation and intra-aortic balloon pump therapy
1例急性心肌梗死合并心源性休克实施体外膜肺氧合及主动脉内球囊反搏术患者护理体会

摘要

目的 通过对1例急性心肌梗死并发心源性休克行体外膜肺氧合（VA-ECMO）、主动脉内球囊反搏（IABP）患者进行护理体验归纳，希望可以给临床上类似患者护理工作带来一定的借鉴意义。方法 回顾性分析2023年11月我科收治1例急性广泛前壁ST段抬高型心肌梗死并发心源性休克病人的相关病历和护理经历。该病人在我院急诊科行经皮冠状动脉介入治疗（PCI）术中出现心跳停止，在行胸外心脏按压后置入VA-ECMO、IABP辅助支持，带着双机械辅助装置乘坐直升机转送我院ICU病房。护理干预内容主要包括VA-ECMO联用IABP跨院转运中的安全协作、IABP反搏功能实时监控及室性期前收缩等心律失常的有效控制、个性化容量调控及个体化的输液治疗计划、多途径有条理性的护理干预和预防导管性血栓形成、VA-ECMO及IABP工作时凝血状况密切监护、医院感染防控全程执行等在内的七大方面。结果 经过多科室联合治疗和综合性的护理措施，在患者第4日撤离VA-ECMO、第13日撤离IABP的过程中，其血流动力学平稳，无因拔除造成的并发症出现。住院期间病人无出现导管相关血流感染、医院内感染、严重出血现象以及下肢缺血等情况，转院过程安全顺利，无导管脱落、设备损坏等情况的发生。病人出院第42天病情好转，生命体征平稳，顺利转入普通病房。结论 针对急性心肌梗死合并心源性休克施行VA-ECMO联合IABP双机械辅助支持治疗患者的护理，制定包含转运过程中的安全性、血流动力学观察、精准化液体控制、多重通路管理、凝出血栓控制、医院感染防护以及下肢缺血观察等全方位、全周期性的护理方案，以医护一体化合作方式实施，是维持机械辅助设备工作稳定，积极防治护理不良事件发生以及帮助病人恢复健康的有效护理措施。

Abstract

Objective To summarize the nursing experience of a patient with acute myocardial infarction complicated by cardiogenic shock who underwent extracorporeal membrane oxygenation (VA-ECMO) and intra aortic balloon counterpulsation (IABP), in order to provide some reference for similar patient nursing work in clinical practice.
Methods A retrospective analysis was conducted on the relevant medical records and nursing experience of a patient with acute extensive anterior ST segment elevation myocardial infarction complicated with cardiogenic shock admitted to our department in November 2023. The patient experienced cardiac arrest during Percutaneous Coronary Intervention (PCI) surgery in our emergency department. After external chest compressions, VA-ECMO and IABP assisted support were placed, and the patient was transferred to our ICU ward by helicopter with dual mechanical assistance devices. The nursing intervention mainly includes seven aspects: safe collaboration during cross hospital transportation of VA-ECMO combined with IABP, real-time monitoring of IABP anti pulsation function and effective control of ventricular premature contractions and other arrhythmias, personalized volume regulation and individualized infusion treatment plan, multi-channel and organized nursing intervention and prevention of catheter-related thrombosis, close monitoring of coagulation status during VA-ECMO and IABP work, and full implementation of hospital infection prevention and control.
Results After multi department combined treatment and comprehensive nursing measures, the patient’s hemodynamics remained stable during the evacuation of VA-ECMO on the 4th day and IABP on the 13th day, with no complications caused by extraction. During hospitalization, the patient did not experience any catheter-related bloodstream infections, hospital acquired infections, severe bleeding, or lower limb ischemia. The transfer process was safe and smooth, with no incidents of catheter dislodgement, detachment, or equipment damage. On the 42nd day of discharge, the patient’s condition improved, vital signs remained stable, and they were successfully transferred to the general ward.
Conclusion   For patients with acute myocardial infarction complicated by cardiogenic shock undergoing VA-ECMO combined with IABP dual mechanical support therapy, a comprehensive and full cycle nursing plan including safety during transportation, hemodynamic observation, precise fluid control, multiple pathway management, coagulation thrombus control, hospital infection prevention, and lower limb ischemia observation should be developed. The implementation of this plan in an integrated medical and nursing cooperation manner is an effective nursing measure to maintain the stability of mechanical assistance equipment, actively prevent and treat nursing adverse events, and help patients recover their health.