原发性血小板增多症患者下肢皮肤顽固性溃疡的循证护理实践

doi:10.3761/j.issn.0254-1769.2020.02.019

摘要/Abstract

摘要：

目的为1例糖尿病合并原发性血小板增多症的患者制订下肢皮肤顽固性溃疡的循证护理方案并实施。方法针对患者临床表现提出问题,计算机检索UpToDATE、乔安娜布里格斯研究所循证卫生保健中心数据库、加拿大安大略注册护士学会网站、美国国家指南库、英国国家临床医学研究所指南库、苏格兰学院间指南网、Cochrane Library、CINAHL、Embase、PubMed、中国生物医学文献数据库、WHO及各类专业协会网站中有关慢性伤口护理的临床指南、证据总结及系统评价。对证据进行可行性、适宜性、临床意义和有效性的评价后,将其应用于患者并观察应用效果。结果最终纳入15篇文献,包括临床决策3篇,指南5篇,证据总结1篇,系统评价6篇。结合患者意愿,在传统治疗和护理的基础上,为其制订针对性的护理方案,包括:暂不停用羟基脲,使用Wagner分级系统对伤口进行全面评估,采用生理盐水和复方黄柏液涂剂清洗伤口,首次采用超声清创,并根据伤口评估结果及时调整清创方法,选择合适的敷料并配合全身治疗。经过16 d的积极治疗,患者伤口感染得到控制、无明显分泌物,无自述疼痛,肉芽组织生长良好,伤口面积缩小,伤口周围皮肤干燥症状消失,好转出院。结论针对糖尿病合并原发性血小板增多症的患者,可以通过循证的方法,给予患者针对、科学、有效的护理措施,减轻患者痛苦、缩短伤口愈合时间、提高患者生活质量。

关键词: 糖尿病, 原发性血小板增多症, 羟基脲, 糖尿病足, 循证护理实践

Abstract:

Objective To develop and implement an evidence-based nursing scheme for a patient with refractory skin ulcer of lower limb suffering from diabetes mellitus combined with essential thrombocytosis. Methods Using PICO principle,questions were put forward based on the clinical manifestations of the patient. We searched databases including UpToDate,Joanna Briggs Institute,Registered Nurses’ Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,Cochrane Library,CINAHL,Embase,Pubmed,CBM,WHO and websites of various professional associations. We included all clinical guidelines,evidence summaries,and systematic reviews on chronic wound care. After evaluating the feasibility,suitability,clinical significance and effectiveness of the evidence,we applied them to the patient and observed its effect. Results A total of 15 studies were finally included,including 3 clinical decisions,5 guidelines,1evidence summary,and 6 systematic reviews. We have formulated a targeted nursing program for the patient. On the basis of traditional treatment and nursing care,the specific program was developed and combined with the willingness of the patient,including no stopping use of hydroxyurea; Wagner grading system was utilized to grade and assess the wound comprehensively; cleaning the wound with normal saline and Compound Cortex Phellodendri liquid coating; performing the first debridement by ultrasonic debridement and adjusting the debridement method in time with the results of the wound assessment according to the wound condition; selecting the suitable dressing and combining with systemic treatment. After 16 days of active treatment,the wound infection of the patient was controlled. There was no obvious secretion,no self-reported pain and the granulation tissue grew well. The wound area was reduced and the symptoms of dry skin around the wound disappeared. The symptoms were improved and the patient was discharged. Conclusions For patients with diabetes mellitus combined with essential thrombocytosis,we can give them targeted,scientific and effective nursing measures through evidence-based methods to reduce the pain of patients,shorten wound healing time and improve the quality of life of patients.

Key words: Diabetes Mellitus, Essential Thrombocytosis, Hydroxyurea, Diabetic Foot, Evidence-based Nursing Practice

刘文驰, 赵旭, 张淑芳, 张振美, 王俊巧, 杨丽娟. 原发性血小板增多症患者下肢皮肤顽固性溃疡的循证护理实践[J]. 中华护理杂志, 2020, 55(2): 266-271.

LIU Wenchi, ZHAO Xu, ZHANG Shufang, ZHANG Zhenmei, WANG Junqiao, YANG Lijuan. Evidence-based nursing practice of a case of stubborn skin ulcer of lower limb in essential thrombocytosis patient[J]. Chinese Journal of Nursing, 2020, 55(2): 266-271.

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