Abstract:

This article summarized the nursing care experience of a pediatric patient with kawasaki disease after off-pump coronary artery bypass grafting. The key points of nursing care include：①the emergency treatment plan of chest pain was formulated before operation to prevent and identify myocardial infarction as soon as possible；early respiratory function training was carried out to improve cardiopulmonary function；risk management was improved to prevent rupture of coronary artery aneurysm. ②The circulatory system was closely monitored to ensure stable hemodynamic performance during operation；fluid balance was maintained to prevent renal function injury.③Posto-perative pain and irritation were managed to prevent atrial fibrillation；the coagulation function was monitored，and coagulation associated complications，such as epistaxis，should be treated timely；non-pharmacological intervention measures were taken to relieve postoperative delirium；individualized exercise rehabilitation care plan was made to enhance recovery；individualized diet plan was made to improve the nutritional status；structural education was enhanced to make the patient and his parents more cooperative. After careful treatment and nursing care，the patient recovered and was discharged from the hospital at 16 days after the surgery without any complications in one-year follow up.

Key words: Kawasaki Disease, Coronary Artery Bypass，Off-Pump, Perioperative Nursing, Pediatric Nursing

摘要：

总结1例川崎病合并巨大冠状动脉瘤患儿在非体外循环下行冠状动脉旁路移植术的围手术期护理经验，护理要点如下。①术前制订胸痛应急处置方案，及早预防、识别心肌梗死；进行早期呼吸功能训练，改善心肺功能；提高风险防范意识，预防冠状动脉瘤体破裂。②术中加强循环系统监测，保证血流动力学稳定；严格控制出入量，预防肾功能损伤。③术后减少刺激、控制疼痛，预防心房颤动；加强凝血功能监测，及时处理鼻出血；采取非药物干预措施，改善术后谵妄；制订个体化运动训练方案，促进快速康复；加强饮食管理，改善营养状况；重视健康宣教，提高患儿及其家长的配合度。经过精心的治疗与护理，患儿于术后16 d康复出院，随访1年，病情恢复良好。

关键词: 川崎病, 冠状动脉旁路移植术，非体外循环, 围手术期护理, 儿科护理学