总结1例左室心肌致密化不全并发暴发性心肌炎患者行体外膜肺氧合的护理。护理要点如下:机械循环辅助期间动态监测患者生命体征变化;加强管道的护理,预防非计划性拔管;实施checklist清单交接管理;加强皮肤护理,降低压力性损伤风险;置管侧肢体缺血性损伤的监测及护理;动态调整抗凝策略,加强血栓及出血管理;落实集束化护理措施,防范和控制感染。患者经过18天的精细化治疗与护理后康复出院。This paper summarizes the nursing care of a patient with left ventricular noncompaction complicated with fulminant myocarditis undergoing extracorporeal membrane oxygenation. The key points of nursing care are as follows: dynamic monitoring of changes in the patient’s vital signs during mechanical circulatory assistance;strengthening the care of the tube to prevent unplanned extubation;implementing checklist handover management;strengthening skin care to reduce the risk of pressure injury;monitoring and nursing of ischemic injury of the cannulated limb;dynamically adjusting the anticoagulation strategy, strengthening the management of thrombosis and bleeding;implementing bundled nursing measures to prevent and control infection. The patient recovered and was discharged after 18 days of meticulous treatment and nursing.
心肌致密化不全(non-compaction of the ventricular myocardium,NVM)是一种罕见的先天性心肌病,与遗传相关异质性心肌病。其主要依赖于心脏超声,心脏核磁对心脏形态学特征的评估。心肌致密化不全的形态学特征是心肌层变薄、致密,心肌小梁层增厚,小梁过多,凹陷较深。受影响的患者可能无症状,也可能出现严重的心脏功能障碍或心源性猝死。心功能不全治疗主要以提高心室射血效率,降低心室前后负荷为原则;治疗心律失常及植入ICD是预防猝死的重要措施;抗凝治疗在合并EF<40%或房颤的患者中意义重大。为了防止不良后果,正确识别和处理这种心肌病至关重要。最新研究甚至提出心肌致密化不全概念错误,其仅仅是心肌的过度小梁化。
