Research progress on integrated nursing model for critically ill patients in cardiac surgery under CRRT combined with ECMO support
心脏外科危重患者CRRT联合ECMO支持下的一体化护理模式研究进展

摘要

心脏外科是临床外科中的重要类型，在相应的手术治疗后患者容易出现心功能不全、严重感染、低心排血量综合征、多器官功能障碍等多种并发症，对其容易出现急性肾损伤，严重者需要开展肾脏替代治疗。为稳定患者的血流动力学，还需要保障器官灌注，从而改善体内环境，临床中常联合生命支持技术挽救患者的生命。连续性肾脏替代治疗（CRRT）是一种持续血液净化技术，从而缓慢平稳清除体内多余水分、代谢废物与炎性介质，以此维持电解质、酸碱与水平衡，减轻心脏负担，使药物应用与营养支持有稳定的环境。体外膜肺氧合（ECMO）是严重呼吸衰竭与心源性休克患者心肺功能的重要支持途径，借助体外循环装置部分或者全部替代心肺功能，以此使心脏与肺脏获得修复与休息的机会，心脏外科领域ECMO能用于多种不良状况的高级生命支持，但其在应用过程中容易出现暴发性心肌炎、术后体外循环难以脱离、心搏骤停以及心脏移植后早期移植物功能不全。一体化护理模式能够给予以上两项技术的复杂性与高风险性开展，其能够良好以患者为中心，开展多个方面的综合护理。

Abstract

Cardiac surgery is an important type of clinical surgery. After the corresponding surgical treatment, patients are prone to complications such as heart failure, severe infection, low cardiac output syndrome, and multiple organ dysfunction. They are also prone to acute kidney injury, and in severe cases, renal replacement therapy is required. To stabilize the patient's hemodynamics, it is also necessary to ensure organ perfusion to improve the internal environment. In clinical practice, life support technologies are often combined to save the patient's life. Continuous renal replacement therapy (CRRT) is a continuous blood purification technology that slowly and steadily removes excess water, metabolic waste, and inflammatory mediators from the body, thereby maintaining electrolyte, acid-base, and fluid balance, reducing the burden on the heart, and providing a stable environment for drug application and nutritional support. Extracorporeal membrane oxygenation (ECMO) is an important support method for the heart and lungs in patients with severe respiratory failure and cardiogenic shock. It partially or completely replaces the function of the heart and lungs through an extracorporeal circulation device, allowing the heart and lungs to have the opportunity to repair and rest. In the field of cardiac surgery, ECMO can be used for advanced life support in various adverse conditions, but it is prone to complications such as fulminant myocarditis, difficulty in weaning from postoperative extracorporeal circulation, cardiac arrest, and early graft dysfunction after heart transplantation. The integrated nursing model can be applied to the complexity and high risk of the above two technologies. It can be well centered on the patient and provide comprehensive nursing in multiple aspects.