1例Ⅳ度骨髓抑制患者并发脓毒症性休克的护理

doi:10.3761/j.issn.0254-1769.2023.13.016

摘要/Abstract

摘要：

总结1例Ⅳ度骨髓抑制患者并发脓毒症性休克的护理经验。护理要点：脓毒症性休克的急救护理；紧急切开未成熟脓肿，超声引导下加强脓腔冲洗，预防并发症的发生；改良全环境保护隔离；根据血糖变化规律动态调整血糖管理策略。经过系统的救治和精细化的护理，患者9 d后病情稳定，转至普通病房继续接受治疗。

关键词: 骨髓抑制, 休克, 脓毒性, 急救, 护理

Abstract:

To summarize the nursing experience of a patient with grade Ⅳ myelosuppression complicated with septic shock. The key points of nursing included the prompting of cooperation with the first aid of septic shock，the close monitoring of infection indicators，the timely assisting for doctors to perform perianal abscess incision beside the bed，the accurate judge and thorough flushing of the abscess cavity under ultrasound guidance，the maintenance of effective drainage，giving patients improved total environmental protection quarantine measures，and the dynamical adjustment of blood glucose management strategies according to the changes of blood glucose. After systematic treatment and meticulous nursing，the patient was in stable condition after 9 days and transferred to the general ward for further treatment.

Key words: Bone Marrow Suppression, Shock, Septic, First Aid, Nursing Care

周晓瑜, 潘政雯, 方珍珍, 应玲玲, 丁旦怡, 章建丽, 许丽炜, 丁淑怡, 叶小娇, 金爱云. 1例Ⅳ度骨髓抑制患者并发脓毒症性休克的护理[J]. 中华护理杂志, 2023, 58(13): 1635-1639.

ZHOU Xiaoyu, PAN Zhengwen, FANG Zhenzhen, YING Lingling, DING Danyi, ZHANG Jianli, XU Liwei, DING Shuyi, YE Xiaojiao, JIN Aiyun. Nursing care of a patient with grade Ⅳ myelosuppression complicated with septic shock[J]. Chinese Journal of Nursing, 2023, 58(13): 1635-1639.

参考文献 19

[1]	贺晶晶. 老年晚期肺癌患者含铂双药化疗中应用聚乙二醇化重组人粒细胞集落刺激因子一级预防3度/4度中性粒细胞减少的临床价值研究[D]. 呼和浩特: 内蒙古医科大学, 2020.
	He JJ. Clinical value of primary prevention of 3/4 degree neutropenia with PEGylated recombinant human granulocyte colo-ny-stimulating factor in platinum-containing dual-drug chemo-therapy for elderly patients with advanced lung cancer[D]. Hohhot: Inner Mongolia Medical University, 2020.
[2]	吴健锋, 栾樱译, 柯路. 脓毒症免疫抑制诊治专家共识[J]. 中华危重病急救医学, 2020, 32(11):1281-1289.
	Wu JF, Luan YY, Ke L. Expert consensus on the diagnosis and treatment of immunosuppression in sepsis[J]. Chin Crit Care Med, 2020, 32(11):1281-1289.
[3]	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8):801-810. DOI PMID
[4]	De Souza DC, Barreira ER, Faria LS. The epidemiology of sepsis in childhood[J]. Shock, 2017, 47(1S Suppl 1):2-5. PMID
[5]	中国中西医结合学会急救医学专业委员会, 《中国中西医结合急救杂志》编辑委员会. 脓毒性休克中西医结合诊治专家共识[J]. 中华危重病急救医学, 2019, 31(11):1317-1323.
	Chinese Society of Integrated Traditional and Western Medicine,Professional Committee of Emergency Medicine, Editorial Committee of Chinese Journal of Integrated Traditional and Western Medicine. Expert consensus on diagnosis and treatment of septic shock with integrated traditional Chinese and Western medicine[J]. Chin Crit Care Med, 2019, 31(11):1317-1323.
[6]	王仲, 魏捷, 朱华栋, 等. 中国脓毒症早期预防与阻断急诊专家共识[J]. 中国急救医学, 2020, 40(7):577-588.
	Wang Z, Wei J, Zhu HD, et al. Expert consensus on early prevention and blocking of sepsis in China[J]. Chin J Crit Care Med, 2020, 40(7):577-588.
[7]	Chen AP, Setser A, Anadkat MJ, et al. Grading dermatologic ad-verse events of cancer treatments:the common terminology criteria for adverse events version 4.0[J]. J Am Acad Dermatol, 2012, 67(5):1025-1039. DOI URL
[8]	中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华内科杂志, 2015, 54(6):557-581.
	Critical Care Medicine Branch of Chinese Medical Association. Guidelines for the treatment of severe sepsis/septic shock in China(2014)[J]. Chin J Intern Med, 2015, 54(6):557-581.
[9]	董建华, 黄力, 李川, 等. 离心/膜分离组合式双重血浆置换治疗重症狼疮性肾炎的临床研究[J]. 肾脏病与透析肾移植杂志, 2021, 30(4):308-314.
	Dong JH, Huang L, Li C, et al. The centrifugal-membranous hybrid double filtration plasmapheresis therapy for severe lupus nephritis[J]. Chin J Nephrol Dial Transplant, 2021, 30(4):308-314.
[10]	龚立超, 常红, 赵洁, 等. 重症抗NMDAR脑炎患者膜式血浆置换护理流程的优化[J]. 中国护理管理, 2022, 22(3):475-480.
	Gong LC, Chang H, Zhao J, et al. Study on the optimal nursing process of membrane plasmapheresis for patients with severe anti-NMDAR encephalitis[J]. Chin Nurs Manag, 2022, 22(3):475-480.
[11]	周晓瑜, 黄丽华, 金爱云, 等. 1例遗传性弥漫性白质脑病合并轴索球样变患者行造血干细胞移植的护理[J]. 中华护理杂志, 2020, 55(6):928-931. DOI URL
	Zhou XY, Huang LH, Jin AY, et al. Nursing care of one patient with hereditary diffuse leukoencephalopathy with spheroids treated with hematopoietic stem cell transplantation[J]. Chin J Nurs, 2020, 55(6):928-931.
[12]	Sahnan K, Adegbola SO, Tozer PJ, et al. Perianal abscess[J]. BMJ, 2017, 356:j475.
[13]	曹敏然. 如意金黄膏对肛周蜂窝织炎和肛周脓肿护场的影响[D]. 北京: 北京中医药大学, 2021.
	Cao MR. Effect of Ruyi Jinhuang ointment on nursing care of perianal cellulitis and perianal abscess[D]. Beijing: Beijing University of Chinese Medicine, 2021.
[14]	韦艳飞, 蒋永江, 韦文永, 等. 1例极低出生体重儿自发性膀胱破裂行密闭式腹腔冲洗术的护理[J]. 中华护理杂志, 2018, 53(3):296-298.
	Wei YF, Jiang YJ, Wei WY, et al. Nursing care of a very low birth weight infant with spontaneous bladder rupture undergoing closed lavage in peritoneal cavity[J]. Chin J Nurs, 2018, 53(3):296-298.
[15]	何小华, 杨守和, 赵月虎, 等. 高频彩色多普勒超声对肛周脓肿患者的诊断评价[J]. 中华医院感染学杂志, 2017, 27(15):3529-3532.
	He XH, Yang SH, Zhao YH, et al. Diagnostic value of high-frequency color Doppler ultrasonography in perianal abscess[J]. Chin J Nosocomiology, 2017, 27(15):3529-3532.
[16]	梅世文, 金黑鹰. 肛旁脓肿的术式选择[J]. 中华结直肠疾病电子杂志, 2016, 5(5):376-379.
	Mei SW, Jin HY. The selections of surgical procedures in perianal abscess[J]. Chin J Colorectal Dis Electron Ed, 2016, 5(5):376-379.
[17]	林燕, 俞超, 王奉涛, 等. 2例异基因造血干细胞移植术后移植物抗宿主病患者行肺移植术的护理[J]. 中华护理杂志, 2022, 57(4):481-486. DOI URL
	Lin Y, Yu C, Wang FT, et al. Nursing care of 2 patients with graft-versus-host disease undergoing lung transplantation after allogeneic hematopoietic stem cell transplantation[J]. Chin J Nurs, 2022, 57(4):481-486.
[18]	李菁菁, 潘文彦, 王晓容, 等. ICU成人危重症患者血糖管理的最佳证据总结[J]. 护理学报, 2021, 28(12):21-26.
	Li JJ, Pan WY, Wang XR, et al. Best evidence summary of blood glucose management for ICU adult patients[J]. J Nurs China, 2021, 28(12):21-26.
[19]	上海市中西医结合学会急救专业委员会, 上海市中西医结合学会重症医学专业委员会, 上海市医师协会急诊科医师分会, 等. 脓毒症急性胃肠功能障碍中西医结合临床专家共识[J]. 中华危重病急救医学, 2022, 34(2):113-120.
	First Aid Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine, Critical Care Medicine Committee of Shanghai Association of Integrated Traditional Chinese and Western Medicine, Emergency Physicians Branch of Shanghai Medical Association, et al. Expert consensus on gastrointestinal dysfunction secondary to sepsis with integrating Traditional Chinese Medicine and Western medicine[J]. Chin Crit Care Med, 2022, 34(2):113-120.