总结1例青少年肺栓塞患者并发呼吸心跳骤停行体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）联合纤维支气管镜冷冻技术及持续血液净化治疗（continuous renal replacement therapy，CRRT）的护理经验。主要措施是快速启动救治预案，提高救治效率；尽早实施目标体温管理，促进神经功能预后；运用纤维支气管镜下冷冻技术清除血凝块，加强气道管理；保护性肺通气策略联合一氧化氮吸入(inhaled nitric oxide，iNO )治疗改善肺通气；循环稳定后将静脉-动脉体外膜肺氧合（vein-artery extracorporeal membrane oxygenation，VA-ECMO）转流为静脉-静脉体外膜肺氧合（vein-vein extracorporeal membrane oxygenation，VV-ECMO），以纠正顽固性低氧血症；联合CRRT治疗进行精准容量管理；落实个体化的抗凝策略和分阶段血液回输技术；加强心理支持。经过25 d积极救治和精细化护理，患者病情平稳，转康复医院继续治疗。出院1个月随访，患者神志清楚，可清晰言语，四肢肌力逐步恢复。该患者的救治过程中，成熟的ECMO团队配合十分重要，可缩短抢救各环节的反应时间，提高救治成功率；而个体化治疗措施的应用及高质量的护理是促进该患者康复的关键。

To summarize the nursing experience of an adolescent patient with pulmonary embolism complicated by respiratory cardiac arrest with extracorporeal membrane oxygenation(ECMO) combined with flexible bronchoscopic cryotherapy and continuous renal replacement therapy(CRRT).The main measures included:promptly initiating the rescue plan to enhance rescue efficiency;early implementation of targeted temperature management to promote neurological function prognosis;using fiberoptic bronchoscopy with cryotherapy to remove blood clots and strengthen airway management;applying protective lung ventilation strategies combined with inhaled nitric oxide(iNO) to improve lung ventilation;converting vein-artery extracorporeal membrane oxygenation(VA-ECMO) to vein-vein extracorporeal membrane oxygenation(VV-ECMO) after stabilizing circulation to correct refractory hypoxemia;precise volume management through combined CRRT treatment;implementing individualized anticoagulation strategies and phased blood transfusion techniques;and providing psychological support.After 25 days of active treatment and meticulous care,the patient’s condition stabilized and was transferred to a rehabilitation hospital for further treatment.One month after discharge,the patient was conscious,could speak clearly,and regained limb muscle strength gradually.In the rescue process of this patient,the cooperation of a mature ECMO team was crucial,as it could shorten the response time of each rescue link and increase the success rate of rescue.The application of individualized treatment measures and high-quality care were the keys to promoting the patient’s recovery.

R473.72；R472.2

江苏省人民医院临床能力提升工程护理面上项目（JSPH-NB-2022-3）