Evidence-based nursing of one heat stroke patient with rhabdomyolysis and multiple organ dysfunction syndrome
10.3760/cma.j.issn.1674-2907.2015.12.033
- VernacularTitle:一例热射病导致横纹肌溶解综合征合并多器官功能衰竭综合征患者的循证护理
- Author:
Ling? WANG
1
;
Youqin YU
;
Donghong SAI
;
Liyan QIU
Author Information
1. 100074 北京，中国航天科工集团七三一医院护理部
- Keywords:
Continuous renal replacement therapy;
Heat stroke;
Rhabdomyolysis;
Evidence-based nursing
- From:
Chinese Journal of Modern Nursing
2015;(12):1465-1468
- CountryChina
- Language:Chinese
-
Abstract:
Objective Using evidence-based nursing method to formulate an nursing program for one heat stroke ( HS) with rhabdomyolysis ( RM) and multiple organ dysfunction syndrome ( MODS) patient, who were treated by continuous renal replacement therapy( CRRT) . Methods Based on fully assessing the patients′conditions, the clinical problems were put forward according to PICO principles. The Cochrane library, MEDLINE, PubMed, EBMR inquiry evidence-based medicine databases, National Guideline Clearinghouse, RNAO, CBM, WanFang database, CNKI and Critical Care Medicine Branch of Chinese Medical Association clinical guidelines were retrieved to collect high quality clinical evidence, and then the optimum nursing program was designed in line with patients′conditions and relatives′willingness. Results Ten trials and one application guideline were included. The available clinical evidence displayed that:(1)HS patient with RM should be given CRRT as soon as possible, it could not only reduce core body temperature, but also effectively removed myoglobin and significantly improved renal function; ( 2 ) Femoral vein catheter was the first choice for establishing vascular access;(3)The systemic anticoagulation with un-fractionated heparin should be scheduled for coagulation laboratory examination and closely observed the hemorrhage; ( 4 ) Routine use of intermittent saline flush pipes was not recommended. So finally a nursing plan was made in combination with literature evidence, patients′ condition and relatives′ willingness: we used CRRT early; choose femoral vein catheter;closely observed of hemorrhage and adjusted the dose of heparin according to activated partial thromboplastin time ( APTT) when using systemic anticoagulation with un-fractionated heparin, not used intermittent saline flush pipes. After CRRT and other comprehensive treatment, the patient regained consciousness after seven days. Myoglobin was down to 200 ng/ ml from 1 455 ng/ ml admission, with astable vital signs. Conclusions HS patients with RM should be given CRRT as soon as possible. Femoral vein catheter is the first choice for establishing vascular access. The systemic anticoagulation with un-fractionated heparin should be scheduled for coagulation laboratory examination and closely observed of hemorrhage. Routine use of intermittent saline flush pipes is not recommended.
