Clinical practice and value exploration of nurse-led exercise therapy in a patient with extensive myocardial infarction complicated with multiple organ failure

To explore the safety, effectiveness, and key nursing points of implementing nurse-led phased exercise therapy for patients with extensive myocardial infarction complicated by multiple organ failure who are receiving multi-organ support including CRRT, VA-ECMO, and IABP. The patient with extensive myocardial infarction complicated by cardiogenic shock and multiple organ failure was selected as the research object. Focusing on the key nursing priorities of "synergistic management of multiple catheters to prevent dislocation, matching exercise load to organ function, and avoiding circulatory and respiratory risks", individualized exercise therapy was implemented in phases on the basis of stable vital signs. Specifically, passive joint movement was the main intervention during the combined support phase; stepped active-assisted exercise was performed in the early weaning transition phase; and endurance and activities of daily living training were emphasized in the post-weaning consolidation phase. Throughout the process, enhanced catheter fixation, psychological intervention, and nutritional support were provided. The effects were comprehensively evaluated through physiological indicators, exercise tolerance, and rehabilitation outcomes. After the intervention, the patient successfully withdrew from all organ support devices. The left ventricular ejection fraction (LVEF), 6-minute walk distance, and activities of daily living (Barthel Index) were significantly improved. No exercise-related adverse events or catheter-related complications occurred. The patient was discharged smoothly after38days of hospitalization with no readmission. For patients with extensive myocardial infarction receiving multiple organ support, phased implementation of exercise therapy under close monitoring can promote organ function recovery and improve exercise tolerance, providing practical reference for critical care rehabilitation. (本文总结1例接受肾脏替代治疗(CRRT)、静脉-动脉体外膜肺氧合(VA-ECMO)及主动脉内球囊反搏(IABP)多器官支持的广泛前壁心肌梗死合并多器官功能障碍综合征(MODS)患者在护士主导下开展分阶段运动疗法的护理经验。围绕多管路协同管理、运动负荷适配及风险防控, 分三阶段实施个体化运动疗法: 联合支持期行被动关节活动, 撤机过渡期行阶梯式主动辅助运动, 撤机后期行耐力训练。全程强化管路固定、心理及营养支持。干预后患者脱离所有器官支持, 左心室射血分数由16%提升至38%, 6分钟步行距离由0 m增至280 m, Barthel指数由10分升至85分, 无运动相关不良事件, 住院38天顺利出院, 随访1个月未再入院。表明护士主导的分阶段运动疗法在多器官支持患者中安全有效, 可为重症康复护理提供参考。)