心脏外科术后电风暴患者的护理

doi:10.3760/cma.j.issn.1007-1245.2023.13.028

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (13): 1896-1899.DOI: 10.3760/cma.j.issn.1007-1245.2023.13.028

心脏外科术后电风暴患者的护理

刘志昌凌云林琼瑜朱苏敏

南方医科大学附属广东省人民医院广东省医学科学院心外重症监护一科，广州　510080

收稿日期:2022-11-05 出版日期:2023-07-01 发布日期:2023-07-24
通讯作者: 朱苏敏，Email：zhusumin2729@163.com
基金资助:
广东省人民医院（广东省医学科学院）护理科研基金（DFJH202128）

Nursing care for patients with electrical storm after cardiac surgery

Liu Zhichang, Ling Yun, Lin Qiongyu, Zhu Sumin

Cardiac Surgery Intensive Care Unit 1, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China

Received:2022-11-05 Online:2023-07-01 Published:2023-07-24
Contact: Zhu Sumin, Email: zhusumin2729@163.com
Supported by:
Nursing Scientific Research Fund of Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) (DFJH202128)

摘要/Abstract

摘要：

目的　总结心脏外科术后电风暴患者的护理经验。方法　选取2020年4月至2022年2月入住广东省人民医院的共7例心脏外科术后发生电风暴患者为研究对象，其中男性6例，女性1例，年龄（51.10±18.67）岁，回顾性分析心脏外科患者术后发生电风暴的护理过程，包括电风暴危险因素识别、血流动力学监测与生命支持、密切关注电解质、抗心律失常药物使用的护理、适度镇静与环境管理、皮肤护理、心理护理，对于循环难以稳定的患者予体外膜肺氧和支持治疗。结果　经积极救治与护理，5例患者的电风暴均得以纠正；1例患者因反复室颤，予体外膜肺氧合支持治疗后，恢复窦性心律；1例患者抢救无效死亡。结论　电风暴可发生在心脏外科手术后任何时间，严密观察心律变化，及时发现、积极治疗及有效的护理措施是稳定患者病情的关键。

关键词:

电风暴, 心脏外科, 重症监护, 护理

Abstract:

Objective　To summarize the nursing experiences for patients with electrical storm after cardiac surgery. Methods　A total of 7 patients with electrical storm after cardiac surgery admitted to Guangdong Provincial People's Hospital from April 2020 to February 2022 were selected as the study objects, including 6 males and 1 female, aged (51.10±18.67) years. The nursing process for patients with electrical storm after cardiac surgery was retrospectively analyzed, including identification of electrical storm risk factors, hemodynamic monitoring and life support, paying close attention to electrolytes, nursing of antiarrhythmic drug use, moderate sedation and environmental management, skin care, psychological care, and extracorporeal membrane oxygen and supportive treatment to patients with difficult circulation stability. Results　After active treatment and nursing, electrical storm was corrected in 5 patients; 1 patient was treated with extracorporeal membrane oxygenation and returned to sinus rhythm due to recurrent ventricular fibrillation; 1 patient died after rescue. Conclusions　Electrical storm can occur at any time after cardiac surgery. Careful observation on rhythm changes, timely detection, active treatment, and effective nursing measures are the keys to stabilize the patients' illness.

Key words:

Electrical storm, Cardiac surgery, Intensive care, Nursing

刘志昌凌云林琼瑜朱苏敏.

心脏外科术后电风暴患者的护理 [J]. 国际医药卫生导报, 2023, 29(13): 1896-1899.

Liu Zhichang, Ling Yun, Lin Qiongyu, Zhu Sumin.

Nursing care for patients with electrical storm after cardiac surgery [J]. International Medicine and Health Guidance News, 2023, 29(13): 1896-1899.

参考文献

[1] Elsokkari I, Sapp JL. Electrical storm: prognosis and management[J]. Prog Cardiovasc Dis, 2021, 66:70-79. DOI: 10.1016/j.pcad.2021.06.007.
[2] 中国心脏重症心律失常专家委员会.成人心血管外科术后心律失常治疗专家共识[J].中国循环杂志,2017,32(7):627-632. DOI:10.3969/j.issn.1000-3614.2017.07.002.
[3] Kwaśniewski W, Filipecki A, Orszulak M, et al. Risk factors and prognostic role of an electrical storm in patients after myocardial infarction with an implanted ICD for secondary prevention[J]. Arch Med Sci, 2018, 14(3):500-509. DOI: 10.5114/aoms.2016.59702.
[4] 韦荣菊.急性心肌梗死早期恶性室性心律风险预测模型的构建[D]. 桂林:桂林医学院,2022.
[5] 汪春妹,韩卫星.ECG参数预测变异型心绞痛合并恶性室性心律失常的研究[J].影像科学与光化学,2022,40(3):641-645.
[6] 柳丽萍,李晓君,杨淑英.心室电风暴19例回顾性分析[J].江苏实用心电学杂志,2011,20(2):130-131. DOI:10.3969/j.issn.1008-0740.2011.02.024.
[7] 贾亚丹,贺秀华,吴帆.急性ST段抬高型心肌梗死患者介入治疗后心律失常发生的影响因素[J].国际医药卫生导报,2021,27(24):3792-3794. DOI:10.3760/cma.j.issn.1007- 1245.2021.24.010.
[8] Soar J, Maconochie I, Wyckoff MH, et al. 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces[J]. Circulation, 2019, 140(24):e826-e880. DOI: 10.1161/CIR.0000000000000734.
[9] 郝秀丽,马虹颖,杨存美,等.1例心搏骤停病人心电除颤6次复苏成功护理体会[J].护理研究,2021,35(18):3383-3384. DOI:10.12102/j.issn.1009-6493.2021.18.039.
[10] 金巧萍,曹敏,陈岚.一次性粘贴电极在急诊"心室电风暴"患者电复律中的应用[J].中华危重病急救医学,2015(3):232. DOI:10.3760/cma.j.issn.2095-4352.2015.03.017.
[11] 余鹏英,蒋礼,张欢.老年患者心瓣膜置换术后并发室性心律失常危险因素分析及预测模型构建[J].老年医学与保健,2022,28(3):564-568,573. DOI:10.3969/j.issn.1008-8296. 2022.03.023.
[12] 马贵清,罗功名,彭瑜,等.急性心肌梗死后心室电风暴的临床进展[J].心血管病学进展,2020,41(11):1156-1159. DOI:10.16806/j.cnki.issn.1004-3934.2020.11.012.
[13] 温少铭,陈瑞微,冷伊,等.急性心肌梗死患者行经皮冠脉介入手术时并发电风暴的抢救及护理[J].国际医药卫生导报,2020,26(7):925-928. DOI:10.3760/cma.j.issn.1007-1245. 2020.07.010.
[14] 陈永龄,贺承健,邓立普.电风暴的机制与治疗[J].实用休克杂志(中英文),2020,4(5):298-302.
[15] Schupp T, Bertsch T, von Zworowsky M, et al. Prognostic impact of potassium levels in patients with ventricular tachyarrhythmias[J]. Clin Res Cardiol, 2020, 109(10):1292-1306. DOI: 10.1007/s00392-020-01624-x.
[16] 中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.室性心律失常中国专家共识基层版[J].中华心律失常学杂志,2022,26(2):106-126. DOI:10.3760/cma.j.cn113859-20220224-00036.
[17] Martinek M, Manninger M, Schönbauer R, et al. Expert consensus on acute management of ventricular arrhythmias - VT network Austria[J]. Int J Cardiol Heart Vasc, 2021, 34:100760. DOI: 10.1016/j.ijcha.2021. 100760.
[18] 中华医学会,中华医学会杂志社,中华医学会全科医学分会,等.室上性心动过速基层诊疗指南(2019年)[J].中华全科医师杂志,2020,19(8):667-671. DOI:10.3760/cma.j.cn114798-20200518-00588.
[19] 曲新华.胺碘酮联合艾司洛尔治疗室性心律失常的疗效观察[J].中国现代药物应用,2022,16(7):86-88. DOI:10.14164/j.cnki.cn11-5581/r.2022.07.030.
[20] 药俊.PCI术后心律失常的护理[J/CD].世界最新医学信息文摘(连续型电子期刊),2019,19(98):350-351. DOI:10.19613/j.cnki.1671-3141.2019.98.197.
[21] Muser D, Santangeli P, Liang JJ. Management of ventricular tachycardia storm in patients with structural heart disease[J]. World J Cardiol, 2017, 9(6):521-530. DOI: 10.4330/wjc.v9.i6.521.
[22] 李威,于怡驰,李毅刚.«2022年欧洲心脏病学会室性心律失常患者管理和心源性猝死预防指南»解读[J].心电与循环,2022,41(5):413-420. DOI:10.12124/j.issn.2095-3933. 2022.5.2022-5216.
[23] 孙玉,宁静,晋桂丽,等.RASS评分表指导ICU机械通气患者目标镇静护理的应用[J].吉林医学,2022,43(4):1118-1119. DOI:10.3969/j.issn.1004-0412.2022.04.100.
[24] 蒋云仙,柯炜,谢美红.老年冠心病患者并发心律失常的影响因素分析及针对性护理对策[J].齐鲁护理杂志,2022,28(21):65-68. DOI:10.3969/j.issn.1006-7256.2022. 21.020.
[25] 张倩.急诊心律失常实施电复律与电除颤的护理要点分析[J/CD].临床医药文献电子杂志,2018,5(30):134. DOI:10.3877/j.issn.2095-8242.2018.30.109.
[26] 吴海宪,邝永炎,刘雪梅.一次性自动粘贴型除颤(起搏)电极在急诊冠状动脉介入术中电风暴的预防及护理[J/CD].中西医结合心血管病电子杂志,2020,8(7):157-158. DOI:10.16282/j.cnki.cn11-9336/r.2020.07.121
[27] Hendriks AA, Szili-Torok T. Editor's Choice-The treatment of electrical storm: an educational review[J]. Eur Heart J Acute Cardiovasc Care, 2018, 7(5):478-483. DOI: 10.1177/2048872618781358.
[28] 王翠翠,宋宁,王丽君.1例ICD术后患者并发心脏填塞和电风暴的护理[J/CD].中西医结合心血管病电子杂志,2019,7(4):5-6,11. DOI:10.3969/j.issn.2095-6681.2019.04.003.
[29] Hshieh TT, Yue J, Oh E, et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis[J]. JAMA Intern Med, 2015, 175(4):512-520. DOI: 10.1001/jamainternmed.2014. 7779.
[30] 王芳,李冰,吴莉.舒适化浅镇静护理干预策略对ICU机械通气患者的影响[J].齐鲁护理杂志,2021,27(23):105-107. DOI:10.3969/j.issn.1006-7256.2021.23.038.

心脏外科术后电风暴患者的护理

Nursing care for patients with electrical storm after cardiac surgery

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