呼吸与危重症医学科作为抗击新型冠状病毒肺炎(COVID-19)疫情的一线临床科室,该科护理承担了病区管理工作、人员管理及物资管理等多项任务,工作量大、任务重.各项管控措施的严格落实保障了科室在疫情期间各项工作的正常开展及运行.本文结合该科疫情期间的护理工作经验进行总结.

Objective To analyze and summarize the practical experience and prognosis of extracorporeal cardiopulmonary resuscitation (ECPR) in the resuscitation of cardiac arrest patients. Methods The clinical data of ECPR patients rescued by our extracorporeal membrane oxygenation (ECMO) team (including departments of cardiothoracic surgery, emergency, cardiology, anesthesiology and intensive care medicine) from January 2012 to December 2017 were collected and retrospectively analyzed. The components of our ECPR team, team cooperation, survival rate and complications were analyzed. Results The 13 ECPR patients were 8 males and 5 females, at an age of 16~69 (median age 44) years. Their primary diseases include acute myocardial infarction, fulminant myocarditis, postoperative surgery, and so on. All the 13 patients underwent V-A ECMO model of femoral arteriovenous intubation. The operation time from cardiac arrest to ECMO establishment was only 26 to 83 (median time 46) min, and the time of ECMO support was 27 to 189 (median time 111) h. The time from ECMO weaning to discharge was 0~21 (median time 7) d. Seven patients were successfully weaned, and 4 were discharged alive. Incision bleeding occurred in 3(23.08%) patients. Five (38.46%) patients had acute renal failure, 1 patient (7.69%) brain death, 2(15.38%) patients with pulmonary infection, 1(7.69%) patient with cardiac tamponade, 1(7.69%) patient with slight limp, and 3(23.08%) patients suffered from multiple organ failure. No complication of amputation or limb ischemia necrosis occurred. Conclusion Skilled and effective teamwork of ECMO and CPR teams, and prompt and rapid initiation of ECPR after cardiac arrest are important factors to ensure the success rate of ECPR treatment.

Objective To summerize the clinical outcomes and experience of extracorporeal membrane oxygenation (ECMO)-supported inter-hospital transport for critically ill patients. Methods Clinical data of 10 critically ill patients undergoing ECMO-supported inter-hospital transport by our ECMO team during June 2016 and January 2018 were collected in this study. The transport distance, transport complications and treatment outcomes were summarized. Results The transport distance of 10 cases was 3.4 to 248.0 km, at an average of 72.6 km. During the transportation, 1 case of V-V ECMO patients (drainage from the right femoral vein and reflux to the right internal jugular vein) had twist of venous tubes, which affected ECMO flow, and 2 cases of V-A ECMO patients (drainage from the right femoral vein and reflux to the right femoral artery) had incision bleeding. All of the 10 cases safely reached our hospital. One patient was cured and discharged, 1 was successfully removed from ECMO but died of pulmonary infection and multiple organ failure, 1 patient died, 2 patients discharged from hospital by themselves because their family finally gave up the treatment, and the left 5 patients became brain death donors for the liver and/or kidneys. Conclusion Inter-hospital transport on ECMO can be safely performed in critically ill patients, and the complications associated with ECMO transport can be controlled. The staffs involved should pay attention to the construction of ECMO multidisciplinary team and standardize the operating procedures.

经桡动脉穿刺在诊疗过程中非常常用,而桡动脉穿刺处术后止血至关重要.目前主要有旋钮式桡动脉压迫止血器和球囊式桡动脉压迫止血器,都存在压迫时间较长的不足,这样会给患者手部造成肿胀、疼痛等不适.笔者针对上述不足,研制出一种新型的桡动脉压迫止血器,经临床使用效果满意.现报道如下.