1例席汉综合征伴感染合并糖尿病酮症酸中毒患者的护理

doi:10.3761/j.issn.0254-1769.2024.07.013

摘要/Abstract

摘要：

总结1例席汉综合征伴感染合并糖尿病酮症酸中毒患者的护理经验。护理要点：早期积极补液，实施目标导向性血糖管理，纠正内环境紊乱；严密观察病情变化，分阶段落实激素替代治疗，预防垂体危象；采取集束化护理措施，预防感染加重；定期随访和疾病宣教，提高患者疾病自我管理能力。经过积极治疗和精心护理，患者未出现严重并发症，病情平稳，情绪良好，顺利出院。

关键词: 席汉综合征, 糖尿病酮症酸中毒, 感染, 护理

Abstract:

The nursing care of a case of Sheehan syndrome with infection and combined with diabetic ketoacidosis was summarized. To improve prognosis of the disease and guarantee patient’s safety，key points of nursing care are as following：sufficient early liquid resuscitation and target-oriented management of blood glucose to correct internal environment disorder；dynamic monitoring of condition，implementing hormone replacement therapy by stages to prevent pituitary crises；to measure the mental state and implement cluster intervention measures to prevent infection worsening；regular follow-up and disease education to improve patients’ disease self-management ability. After positive treatment and careful nursing care，no serious complications occurred，blood glucose was controlled well，and the case was in stable conditions and was discharged.

Key words: Sheehan’s Syndrome, Diabetic Ketoacidosis, Infection, Nursing Care

曾莉容, 张星, 陈浩莹. 1例席汉综合征伴感染合并糖尿病酮症酸中毒患者的护理[J]. 中华护理杂志, 2024, 59(7): 854-858.

ZENG Lirong, ZHANG Xing, CHEN Haoying. Nursing care of a case of Sheehan syndrome with infection and combined with diabetic ketoacidosis[J]. Chinese Journal of Nursing, 2024, 59(7): 854-858.

参考文献 16

[1]	Matsuzaki S, Endo M, Ueda Y, et al. A case of acute Sheehan’s syndrome and literature review:a rare but life-threatening com-plication of postpartum hemorrhage[J]. BMC Pregnancy Child-birth, 2017, 17(1):188.
[2]	Siddiqui SS, Dominic N, Kumar S, et al. A challenging diag-nosis of sheehan’s syndrome in non-obstetric critical care and emergency Settings:a case series of five patients with varied presentations[J]. J Crit Care Med, 2022, 8(3):214-222. DOI PMID
[3]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4):315-409.
	Chinese Medical Association Diabetes Mellitus Branch. Guide-line for the prevention and treatment of type 2 diabetes mel-litus in China (2020 edition)[J]. Chin J Diabetes, 2021, 13(4):315-409.
[4]	Kovacs K. Sheehan syndrome[J]. Lancet, 2003, 361(9356):520-522. DOI PMID
[5]	Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical prac-tice consensus guidelines 2022:diabetic ketoacidosis and hy-perglycemic hyperosmolar state[J]. Pediatr Diabetes, 2022, 23(7):835-856. DOI URL
[6]	Roberts A, James J, Dhatariya K, et al. Management of hyper-glycaemia and steroid(glucocorticoid) therapy:a guideline from the Joint British Diabetes Societies(JBDS) for inpatient care group[J]. Diabet Med, 2018, 35(8):1011-1017. DOI URL
[7]	White K, Wass J. Steroid-dependent patients with multiple co-morbidities are more vulnerable to adrenal crisis[J]. Endocr Abstr, 2015, 38:416.
[8]	Adan AM, Jeele MOO, Siyad MO, et al. Sheehan syndrome pre-senting as acute renal failure:a rare case report from Somalia[J]. Ann Med Surg(Lond), 2022, 82:104641.
[9]	Vercueil A. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency:a reply[J]. Anaesthesia, 2020, 75(10):1398-1399. DOI PMID
[10]	郭桂华, 许小明, 王海靓, 等. 脑卒中呼吸系统感染患者气道管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(1):31-38. DOI URL
	Guo GH, Xu XM, Wang HL, et al. Summary of the best evidence of airway nursing management in patients with respiratory infection after stroke[J]. Chin J Nurs, 2023, 58(1):31-38. DOI URL
[11]	中华医学会内分泌学分会, 中国内分泌代谢病专科联盟. 糖皮质激素类药物临床应用指导原则(2023版)[J]. 中华内分泌代谢杂志, 2023, 39(4):289-296.
	Chinese Medical Association Endocrinology Branch, China Endo-crinology and Metabolic Disease Specialist Alliance. Principles for clinical applica-tion of glucocorticoids(2023 edition)[J]. Chin J Endocrinol Metabol, 2023, 39(4):289-296.
[12]	傅来建, 卢芳燕. 1例肝移植术后肺部卡氏肺孢子感染并发颅内出血患儿的护理[J]. 中华护理杂志, 2022, 57(8):996-1000. DOI URL
	Fu LJ, Lu FY. Nursing care of a child with Pneumocystis Carinii infection and intracranial hemorrhage after liver transplantation[J]. Chin J Nurs, 2022, 57(8):996-1000. DOI URL
[13]	杨书环, 杨贵芳, 田桂荣, 等. 集束化护理降低急性白血病化疗患者肺部感染发病率的效果研究[J]. 中国感染控制杂志, 2023, 22(4):435-441.
	Yang SH, Yang GF, Tian GR, et al. Effect of bundled care on reducing the incidence of pulmonary infection in patients with acute leukemia receiving chemotherapy[J]. Chin J Infect Control, 2023, 22(4):435-441.
[14]	陈如梦, 傅荣, 徐任菊. 糖皮质激素维持治疗患者自我感受的质性研究[J]. 中华护理杂志, 2019, 54(9):1364-1369. DOI URL
	Chen RM, Fu R, Xu RJ. Self-perception of patients receiving glucocorticoid maintenance therapy:a qualitative study[J]. Chin J Nurs, 2019, 54(9):1364-1369.
[15]	冯双双, 潘行山, 李娟, 等. 成人腺垂体功能减退症患者临床特征及并发感染的危险因素[J]. 中国医师杂志, 2023, 25(5):704-708.
	Feng SS, Pan XS, Li J, et al. Clinical characteristics and risk factors for concurrent infection in adult patients with hypopituitarism[J]. J Chin Physician, 2023, 25(5):704-708.
[16]	李禹兵, 高凌. 垂体危象的诊治总结与回顾[J]. 内科急危重症杂志, 2017, 23(4):265-268.
	Li YB, Gao L. Summary and review of diagnosis and treat-ment of pituitary crisis[J]. J Intern Intensive Med, 2017, 23(4):265-268.