关键词: 体外膜肺氧合, 肢体缺血, 血管旁路移植术, 儿科护理学, 围手术期护理

Abstract:

To summarize the nursing experience of a child with severe cardiopulmonary failure caused by fulminant myocarditis who underwent autologous vascular bypass grafting after severe lower limb ischemia during extracorporeal membrane oxygenation therapy. The key points of nursing include：①keeping the distal perfusion tube unobstructed before surgery to avoid aggravation of ischemia of the affected limb；physical precautions for deep vein thrombosis are strictly implemented to ensure the patency of the saphenous vein. ②intraoperative nursing cooperation for the conversion of venous-arterial-venous extracorporeal membrane oxygenation to venous-venous extracorporeal membrane oxygenation. ③on the premise of ensuring systemic perfusion after surgery，the blood pressure should be strictly controlled to prevent the rupture of the grafted vessel；to strengthen the management of coagulation to prevent bleeding and thrombosis；different position management of both lower limbs to keep the grafted blood vessels patency；to develop individualized exercise programs to enhance nutrition and promote rapid recovery；to give individualized psychological nursing care including childlike fun and sense of security，and eliminate children’s negative emotions；to develop systematic health guidance and follow-up to improve the quality of family care for children. After treatment and nursing care，the postoperative grafted blood vessels were well anastomosed with no limb ischemia，and there was no swelling of the limb in the saphenous vein donor area. After 41 days of the treatment，the extracorporeal membrane oxygenation was withdrawn. The child recovered and discharged after 122 days；after 2 years of follow-up，the child could walk normally and recovered well.

Key words: Extracorporeal Membrane Oxygenation, Limb Ischemia, Vascular Bypass Grafting, Pediatric Nursing, Perioperative Nursing