1例脓毒性休克患儿双下肢循环障碍继发肢端坏死的护理

doi:10.3761/j.issn.0254-1769.2025.24.014

摘要/Abstract

摘要：

总结1例脓毒性休克患儿双下肢循环障碍继发肢端坏死的护理经验。护理要点：成立多学科个案管理小组，保障患儿安全；开展脓毒性休克的集束化护理，恢复器官功能；进行肢端坏死的风险识别，采取多种护理策略，挽救下肢功能；基于湿性愈合理论，实施分阶段干预策略，助力创面再生。经过多学科团队精心的治疗与护理，患儿入院14 h下肢循环恢复正常，入院101 d器官功能及创面恢复转至普通病房，133 d康复出院。

关键词: 脓毒性休克, 肢端坏死, 创面治疗, 儿科护理学

Abstract:

To summarize the nursing management of a pediatric case with septic shock accompanied by bilateral lower extremity circulatory impairment and acral necrosis. Key interventions included：establishing a multidisciplinary case management team to ensure patient safety； implementing sepsis resuscitation bundles to restore organ function； performing risk identification for limb necrosis and adopting multiple care strategies to save lower extremity function； a staged intervention strategy based on the theory of wet healing to help regenerate wounds. Through multidisciplinary treatment，the child’s lower limb circulation returned to normal within 14 hours of hospitalization，organ function and wound recovery by day 101（transferred to the general ward），and was discharged after 133 days.

Key words: Septic Shock, Distal Necrosis, Wound Therapy, Pediatric Nursing

杨程, 李佳蔚, 冯先琼. 1例脓毒性休克患儿双下肢循环障碍继发肢端坏死的护理[J]. 中华护理杂志, 2025, 60(24): 3036-3039.

YANG Cheng, LI Jiawei, FENG Xianqiong. Nursing care of a child with septic shock with circulatory disturbances in both lower limbs secondary to limb necrosis[J]. Chinese Journal of Nursing, 2025, 60(24): 3036-3039.

参考文献 17

[1]	胡莉, 黄海燕, 程维. 脓毒症的早期识别及护理研究进展[J]. 中华急危重症护理杂志, 2021, 2(4):365-369.
	Hu L, Huang HY, Cheng W. Early identification and nursing progress of sepsis[J]. Chin J Emerg Crit Care Nurs, 2021, 2(4):365-369.
[2]	Bassat Q, Blau DM, Ogbuanu IU, et al. Causes of death among infants and children in the child health and mortality preven-tion surveillance(CHAMPS) network[J]. JAMA Netw Open, 2023, 6(7):e2322494. DOI URL
[3]	中华医学会急诊医学分会. 脓毒症并发弥散性血管内凝血诊治急诊专家共识[J]. 中华危重病急救医学, 2017, 29(7):577-580.
	Emergency Medicine Branch of the Chinese Medical Associa-tion. Chinese emergency medicine expert consensus on diag-nosis and treatment of sepsis complicated with disseminated intravascular coagulation[J]. Chin Crit Care Med, 2017, 29(7):577-580.
[4]	Merdji H, Levy B, Jung C, et al. Microcirculatory dysfunction in cardiogenic shock[J]. Ann Intensive Care, 2023, 13(1):38. DOI PMID
[5]	Zhang NJ, Yu L, Xiong ZX, et al. Kawasaki disease complicated by peripheral artery thrombosis:a case report and literature review[J]. Pediatr Rheumatol Online J, 2022, 20(1):77. DOI
[6]	Kalimouttou A, Lerner I, Cheurfa C, et al. Machine-learning-derived sepsis bundle of care[J]. Intensive Care Med, 2023, 49(1):26-36. DOI
[7]	Rodrigues-Santos G, de Magalhães-Barbosa MC, Raymundo CE, et al. Improvement of 1st-hour bundle compliance and sepsis mortality in pediatrics after the implementation of the surviv-ing sepsis campaign guidelines[J]. J Pediatr (Rio J), 2021, 97(4):459-467. DOI URL
[8]	程晔, 应佳云, 刘彦婷, 等. 《2020拯救脓毒症运动国际指南:儿童脓毒性休克和脓毒症相关器官功能障碍管理》解读[J]. 中国小儿急救医学, 2020, 27(4):241-248.
	Cheng Y, Ying JY, Liu YT, et al. Interpretation of the surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children[J]. Chin Pediatr Emerg Med, 2020, 27(4):241-248.
[9]	Taira T, Inoue A, Okamoto H, et al. Fluid balance during acute phase extracorporeal cardiopulmonary resuscitation and out-comes in OHCA patients:a retrospective multicenter cohort study[J]. Clin Res Cardiol, 2024.
[10]	Farkas DT, Rahnemai-Azar AA, Kunhammed SS, et al. Realistic survival outcomes after vasopressor use in the intensive care unit[J]. Am J Hosp Palliat Care, 2016, 33(9):871-874. PMID
[11]	Smith EC, Patel JN, Wahba A, et al. Acute sympathetic blo-ckade improves insulin-mediated microvascular blood flow in the forearm of adult human subjects with obesity[J]. J Am Heart Assoc, 2024, 13(16):e030775. DOI URL
[12]	Amson H, Vacheron CH, Thiolliere F, et al. Core-to-skin tem-perature gradient measured by thermography predicts day-8 mortality in septic shock:a prospective observational study[J]. J Crit Care, 2020, 60:294-299. DOI URL
[13]	Hasanin A, Fekry R, Mostafa M, et al. The use of thermal imag-ing for evaluation of peripheral tissue perfusion in surgical patients with septic shock[J]. BMC Anesthesiol, 2024, 24(1):109. DOI PMID
[14]	Rahmani C, Belhadj A, Aissaoui Y. Can plethysmographic ca-pillary refill time predict lactate during sepsis? An observa-tional study from Morocco[J]. Afr J Emerg Med, 2024, 14(3):167-171. DOI PMID
[15]	Levy RA, Reiter PD, Spear M, et al. Peripheral vasoactive ad-ministration in critically ill children with shock:a single-center retrospective cohort study[J]. Pediatr Crit Care Med, 2022, 23(8):618-625. DOI URL
[16]	张媛媛, 龙秀红, 吕婵, 等. 1例药液外渗致慢性难愈性创面形成患者的中西医结合护理[J]. 中华护理杂志, 2024, 59(7):808-811. DOI URL
	Zhang YY, Long XH, Lü C, et al. Integrative nursing experie-nce of a case with chronic refractory wound formation caused by drug extravasation[J]. Chin J Nurs, 2024, 59(7):808-811.
[17]	林光燕, 熊俊, 魏平, 等. 1例急性淋巴细胞白血病合并腹股沟坏死性筋膜炎患儿的护理[J]. 中华护理杂志, 2022, 57(2):212-215. DOI URL
	Lin GY, Xiong J, Wei P, et al. Nursing care of a child with acute lymphoblastic leukemia complicated with inguinal necrotizing fasciitis[J]. Chin J Nurs, 2022, 57(2):212-215.