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 After 41 days of the treatment，the extracorporeal membrane oxygenation was withdrawn.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

摘要：

总结1例暴发性心肌炎导致心肺功能衰竭患儿，在体外膜肺氧合治疗期间发生严重下肢缺血后行自体血管旁路移植术的围手术期护理经验。护理要点：①术前保持远端灌注导管通畅，避免下肢缺血加重；严格执行深静脉血栓物理预防措施，保证大隐静脉通畅。②术中做好静脉-动脉-静脉体外膜肺氧合转换为静脉-静脉体外膜肺氧合的护理配合。③术后在保证全身灌注的前提下，严格进行目标血压管理，防止移植血管破裂；加强出凝血管理，预防出血及血栓形成；对双下肢进行不同的体位管理，保持移植血管通畅；制订个体化运动方案，加强营养支持，促进快速康复；给予个体化心理护理，减轻负性情绪；开展系统化健康指导及随访，提高患儿家庭照护质量。经积极治疗和精心护理后，患儿移植血管吻合良好，术后无肢体缺血表现，在体外膜肺氧合治疗41 d后撤机，住院122 d后康复出院。随访2年患儿能正常行走，病情恢复良好，已回归正常学习生活。

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