ECMO治疗期间出血及感染并发症的护理管理策略研究

Nursing Management Strategy of Bleeding and Infection Complications during ECMO Treatment

摘要: 目的：探讨基于循证护理的管理策略在降低ECMO治疗期间出血和感染并发症及提高撤机成功率中的效果，为优化临床护理管理提供科学依据。方法：选择2023年2月至2024年10月接受ECMO治疗的70例患者，按随机数表法分为观察组和对照组，每组各35例。对照组实施常规护理，观察组在此基础上采用基于循证护理的管理策略，包括个性化抗凝方案、感染防控优化、多学科协作及系统化健康教育。比较两组患者的出血发生率、出血严重程度(BARC评分)、感染发生率及ECMO首次撤机成功率。结果：观察组出血发生率显著低于对照组(17.14% vs. 34.29%, P < 0.05)，BARC评分较对照组明显改善(P = 0.008)；感染发生率观察组为14.29%，显著低于对照组的28.57% (P < 0.05)；观察组ECMO首次撤机成功率为82.86%，显著高于对照组的65.71% (P < 0.05)。结论：基于循证护理的管理策略能显著降低ECMO治疗期间的出血和感染并发症，改善患者出血严重程度，并提高首次撤机成功率。这一护理干预方法为优化ECMO治疗的临床护理管理提供了重要参考，具有较高的临床应用价值。

Abstract: Objective: To explore the effect of evidence-based nursing management strategy in reducing bleeding and infection complications and improving the success rate of withdrawal during ECMO treatment, so as to provide scientific basis for optimizing clinical nursing management. Methods: A total of 70 patients receiving ECMO from February 2023 to October 2024 were selected and divided into observation group and control group according to random number table method, with 35 cases in each group. The control group received routine nursing, and the observation group received evidence-based nursing management strategies, including personalized anticoagulation program, optimization of infection prevention and control, multidisciplinary collaboration and systematic health education. The bleeding rate, bleeding severity (BARC score), infection rate and ECMO withdrawal success rate were compared between the two groups. Results: The incidence of hemorrhage in the observation group was significantly lower than that in the control group (17.14% vs. 34.29%, P < 0.05), and the BARC score was significantly improved (P = 0.008). The incidence of infection in observation group was 14.29%, which was significantly lower than that in control group (28.57%) (P < 0.05). The success rate of first ECMO withdrawal in observation group was 82.86%, which was significantly higher than 65.71% in control group (P < 0.05). Conclusion: Evidence-based nursing management strategy can significantly reduce bleeding and infection complications during ECMO treatment, improve the severity of bleeding, and increase the success rate of the first withdrawal. This nursing intervention method provides an important reference for optimizing the clinical nursing management of ECMO treatment, and has high clinical application value.