1例ECMO联合IABP过渡至左心室辅助装置植入救治终末期心衰患者的个案护理

Case Nursing of 1 Patient Treated with ECMO Combined with IABP Transitioning to Left Ventricular Assist Device Implantation for End-Stage Heart Failure

摘要: 目的：总结1例应用VA-ECMO与IABP联合支持成功过渡至左心室辅助装置(LVAD)植入的终末期心力衰竭患者的围术期多阶段护理经验。方法：对1例47岁心源性休克患者，在VA-ECMO与IABP联合支持下行LVAD植入术。围术期护理分为术前准备期、术后急性期、稳定康复期及出院准备期四个阶段，护理重点包括：① ECMO与IABP的协同管理与并发症预防；② 向LVAD支持过渡期间的精准循环监测与个体化抗凝管理；③ 驱动线感染的集束化预防策略；④ 贯穿始终的多阶段康复训练与系统化出院指导。结果：经过76天的治疗与精细化护理，患者未发生严重并发症，成功撤除ECMO及IABP，LVAD工作良好，心功能改善，康复出院。结论：对于循环崩溃的终末期心衰患者，ECMO与IABP联合应用是通向LVAD植入的有效“桥接”策略。在此过程中，全面、动态且具有预见性的专业化护理是保障治疗成功、患者安全康复的关键环节。

Abstract: Objective: To summarize the multi-stage perioperative nursing experience of a patient with end-stage heart failure who successfully transitioned to left ventricular assist device (LVAD) implantation after combined support with VA-ECMO and IABP. Methods: A 47-year-old patient with cardiogenic shock underwent LVAD implantation under the combined support of VA-ECMO and IABP. The perioperative nursing was divided into four stages: preoperative preparation period, postoperative acute period, stable rehabilitation period, and discharge preparation period. The key points of nursing included: ① Collaborative management of ECMO and IABP and prevention of complications; ② Precise circulatory monitoring and individualized anticoagulation management during the transition to LVAD support; ③ Clustered prevention strategies for drive line infection; ④ Comprehensive multi-stage rehabilitation training and systematic discharge guidance throughout the process. Results: After 76 days of treatment and meticulous nursing, the patient did not experience serious complications, successfully removed ECMO and IABP, the LVAD was working well, the cardiac function improved, and the patient was discharged safely. Conclusion: For patients with end-stage heart failure with circulatory collapse, the combined application of ECMO and IABP is an effective “bridging” strategy for LVAD implantation. During this process, comprehensive, dynamic, and predictive specialized nursing is a key link to ensure the success of treatment and the safe recovery of patients.