1例ECMO支持下经支气管镜钬激光介入治疗重度气道狭窄患者的护理

Nursing Care of a Patient with Severe Airway Stenosis Treated by Endobronchial Holmium Laser Intervention under ECMO Support

摘要: 总结1例骨化性气管支气管病致重度大气道狭窄并发气道梗阻、呼吸衰竭患者在静脉–静脉体外膜肺氧合(VV-ECMO)支持下行支气管镜钬激光介入治疗的护理经验。护理要点包括：多学科协作下快速建立并精细维护VV-ECMO，维持环路稳定运行；实施超保护性肺通气策略与人工气道安全核查清单管理；做好ECMO血路、气路、电路、水路及抗凝的精细化管理；全程分阶段实施出血与凝血的平衡管理；做好ECMO支持下院内转运及多次气道钬激光介入治疗的围手术期护理；落实感染防控、体温精准管理及清醒ECMO患者的心理支持与早期康复。经积极治疗与精心护理，患者未发生出血、血栓、感染等严重并发症，于置管后第13天成功撤除ECMO，第14天成功撤离呼吸机，气道狭窄程度由95%改善至50%，顺利出院。

Abstract: This article summarizes the nursing experience of a patient with severe central airway stenosis caused by tracheobronchopathia osteochondroplastica, complicated by airway obstruction and respiratory failure, who underwent bronchoscopic holmium laser interventional therapy with venovenous extracorporeal membrane oxygenation (VV-ECMO) support. The key nursing points included rapid establishment and refined maintenance of VV-ECMO under multidisciplinary collaboration to ensure stable circuit operation; implementation of an ultra-lung-protective ventilation strategy together with a safety checklist for artificial airway management; meticulous management of the ECMO circuit, including the blood path, gas path, power supply and water path, as well as anticoagulation; stage-based balanced management of bleeding and coagulation throughout the treatment course; nursing care during ECMO-supported intra-hospital transport and repeated bronchoscopic holmium laser interventions; and implementation of infection prevention and control, precise temperature management, psychological support and early rehabilitation for the awake ECMO patient. With active treatment and meticulous nursing care, the patient developed no severe complications such as bleeding, thrombosis or infection. ECMO was successfully weaned on day 13 and mechanical ventilation was weaned on day 14 after cannulation, the degree of airway stenosis improved from 95% to 50%, and the patient was discharged uneventfully.