Main points of nursing care strategies on treatment of children with refractory Kawasaki disease by infliximab and literature review

doi:10.3877/cma.j.issn.1673-5250.2020.06.015

Objective

To summarize main points of nursing care strategies on treatment of children with refractory Kawasaki disease (rKD) by infliximab (IFX).

Methods

One case of rKD child (male, 1 year and 5 months old) who was hospitalized in Chengdu Women′s and Children′s Central Hospital from August 25 to September 7, 2019, and treated with IFX was chosen as research subject. His clinical data was analyzed retrospectively.Main points of nursing care strategies applied to him covered the entire process of applying IFX treatment, including retrieve IFX from the pharmacy and its delivery, preparation, related first aid supplies′ preparation, intravenous infusion of IFX in a stepwise increase manner, observation of disease conditions during and after infusion, as well as prevention and control of infection. Literature about nursing care of IFX in treatment of rKD children, nursing care measures for adverse reactions of IFX in treatment of other diseases, and nursing care measures of IFX in treatment of other diseases, were collected from China National Knowledge Infrastructure database, Wanfang Data Knowledge Service Platform and PubMed database, and review the relevant literature.This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

Results

①After applied above mentioned nursing care strategies to this case of rKD child during IFX treatment, he achieved good treatment results and without any adverse reactions, and was discharged smoothly. ② Results of literature review: in a piece of literature, a total of 8 cases of rKD children who didn′t have any adverse reactions during application of IFX through nursing care measures of correctly medicine preparation, strictly follow the operating procedures and strengthen medication observation. In two pieces of literature, the psoriasis and ankylosing spondylitis patients occurred adverse reactions during treatment of IFX, and after symptomatic treatment, patients with mild adverse reactions could continue IFX treatment, and patients with moderate or severe adverse reactions should stopped. In 26 pieces of literature, patients with other diseases, such as Crohn disease etc., whose adverse reactions could be prevented, reduced or avoided during IFX treatment through nursing care measures of relevant training to nursing staff in advance, health education for patients and their family members, preventive use of antihistamines to patients before IFX treatment, use IFX in accordance with regulations, and enhanced observation of patients during medications.

Conclusions

Intravenous infusion of IFX to children with rKD may be safe and effective after taking appropriate nursing care measures that covered above main points.

Key words: Mucocutaneous lymph node syndrome, Infliximab, Immunoglobulins, intravenous, Methylprednisolone, Nursing care, Drug-related side effects and adverse reactions, Child

表1 本例难治性川崎病患儿英夫利西单抗输液方案

输注IFX药液时间(min)	输液速率(mL/h)	输入IFX药液量(mL)	剩余IFX药液量(mL)
0～15	10	2.5	122.5
16～30	20	5.0	117.5
31～45	40	10.0	107.5
46～60	50	12.5	95.0
61～155	60	95.0	0

表1 本例难治性川崎病患儿英夫利西单抗输液方案

输注IFX药液时间(min)	输液速率(mL/h)	输入IFX药液量(mL)	剩余IFX药液量(mL)
0～15	10	2.5	122.5
16～30	20	5.0	117.5
31～45	40	10.0	107.5
46～60	50	12.5	95.0
61～155	60	95.0	0

图1 本例难治性川崎病患儿(男性，1岁5个月)住院期内每日最高体温变化曲线及主要药物治疗情况

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