异基因造血干细胞移植合并会阴部坏死性皮肤软组织感染患者1例的护理

总结1例异基因造血干细胞移植合并会阴部坏死性皮肤软组织感染患者的护理经验。通过烧伤科、皮肤科、整形科、妇科及伤口专科等多学科联合会诊制定合理方案,对患者进行个性化的心理护理,做好伤口评估及换药护理,加强疼痛管理、用药护理,积极予以营养支持和严格落实隔离管理等措施,促进患者会阴部坏死性皮肤软组织感染伤口的愈合,提高了患者的生活质量。     

1例白血病合并多处皮肤软组织感染并发败血症患者的护理

总结1例急性淋巴细胞白血病患者合并多处皮肤软组织感染并发败血症患者的护理经验。护理要点：充分评估后果断采取外科清创,减少毒素吸收;控制全身和局部感染;重视化疗期伤口护理;加强营养支持;注重患者心理护理。经过383d的伤口换药和13次全身化疗,伤口全部愈合,患者病情稳定。     

37例会阴部急性坏死性筋膜炎患者的护理

急性坏死性筋膜炎是由多种细菌感染引起的会阴部、阴囊、肛门周围软组织大范围、快速坏死的重症病症,其死亡率高。报告了37例会阴部急性坏死性筋膜炎患者的护理。包括术前做好心理护理,帮助患者消除恐惧、悲观情绪;进行健康教育和术前准备;术后严密病情观察与监护,通过体温观察判断清创的程度;掌握创面观察指标及特点,及时判断皮下筋膜坏死的范围;防止皮肤、口腔、泌尿系感染;做好换药护理促进创面愈合;对并发症及早抢救与护理。本组36例治愈,1例死于感染中毒性休克多器官功能衰竭。     

CT引导下急性坏死性胰腺炎导管引流术15例的护理

目的探讨CT引导下行经皮穿刺导管引流术的护理体会。方法 15例急性坏死性胰腺炎合并感染患者行CT引导下经皮穿刺导管引流术,患者术前、术中、术后均予规范化护理。结果 15例急性坏死性胰腺炎合并感染的患者放置引流管18根。15例患者经术前、术中、术后规范化护理,无1例出现与经皮穿刺导管引流术相关并发症。结论 CT引导下经皮穿刺导管引流术,规范化护理可有效控制感染,是治疗急性坏死性胰腺炎合并感染的有效和安全方法。     

糖尿病左下肢急性坏死性筋膜炎1例清创术后的护理

坏死性筋膜炎( necrotizing fasciitis,NF)是一种比较少见的急性坏死性软组织感染,起病急,发展迅速,病情重,多以厌氧菌感染为主.若未及时获得合理治疗与护理,可引起明显毒血症[1].我科2011-03-09收治1例糖尿病左下肢急性坏死性筋膜炎患者,护理体会如下.1病历摘要男,56岁.8岁时因左小腿外伤,伤口久不愈合,间断渗液,有窦道形成,有8 a糖尿病史.2011-02-18患者左下肢渗液增多,肿痛明显,出现脓疱,到外院行简单清创、消炎等治疗,病情控制不佳,遂于2011-03-09至我院治疗,急诊以左下肢坏死性筋膜炎收治入院.病程中患者间断发热,最高达39.4℃.     

1例系统性红斑狼疮并发肛周坏死性筋膜炎患者的护理

回顾分析1例系统性红斑狼疮并发肛周坏死性筋膜炎男性患者的临床资料,总结其护理方法。此患者臀周和左腿屈侧感染严重,且由于入院前滥用激素,导致感染扩散,难以控制,根据此患者的病情特点,重点做好感染控制、心理护理、伤口及肛周皮肤护理等,经过2个多月的治疗护理,患者症状缓解出院。     

特重度爆震伤1例的多学科专业化护理实践

总结1例特重度爆震伤患者的多学科专业化护理实践经过。护理要点为:依托多学科护理团队合作,休克期重点做好液体管理及早期胃肠道复苏;休克期过后,在烧伤专科护理的基础上加强视神经损伤和肾小管远端酸中毒护理,分阶段落实气道管理方案,防范导管相关性血流感染,开展多模式镇痛管理;全程做好心理干预和功能锻炼。本例患者于伤后69 d康复出院。     

直肠癌术后并发坏死性筋膜炎1例罗伊适应模式护理

<正>坏死性筋膜炎是一种较少见的外科感染性疾病,病情进展快,侵袭性强,以往称为急性链球菌坏疽或医院坏疽,是一种少见而严重的软组织感染,其特征是广泛而迅速的皮下组织和筋膜坏死,常伴有全身中毒性休克[1]。2013年10~12月,笔者在解放军总医院实习过程中应用罗伊适应模式护理1例直肠癌术后并发坏死性筋膜炎患者,经积极护理,效果满意。现报告如下。1临床资料患者女,52岁,农民,既往体健。2013年10月18日因间     

糖尿病患者肾移植术后并发感染的防治措施及护理

目的 通过总结终末期糖尿病肾病患者肾移植术后感染的防治措施及护理体会,提高手术成功率,减少并发症的发生.方法 回顾性分析67例终末期糖尿病肾病患者行肾移植术后并发感染的临床资料.采取的护理措施主要有:精心的术前准备和全程消毒隔离工作;强化血糖控制;加强呼吸道护理,防治肺部感染;严格无菌操作,防治泌尿系感染;注重基础护理,防治皮肤软组织感染.结果 67例患者中,术后并发感染9例,发生率为13.4%.其中,肺部感染5例,泌尿系感染3例,皮肤软组织感染1例.结论 重视围手术期无菌操作,加强呼吸道和基础护理,对防治术后感染,提高受体肾存活率极为重要.     

自制串接法负压引流在1例盆腔脓肿伴深部软组织感染创口护理中的应用

总结1例盆腔脓肿伴右下肢软组织感染致全身脓毒血症患者的创口护理。在全身抗感染治疗的同时,右下肢深部软组织多处错层切开,盆腔脓肿在CT引导下行置管,采用盆腔高位冲洗、右下肢自制串接法低位负压引流,全身情况得到了有效的控制,创面逐渐好转直至愈合,并通过对患者疼痛、营养、心理、患肢功能等方面的评估及干预,加速了患者康复的时间。经36d治疗,患者感染控制,创面基本愈合,康复出院。     

Necrotizing soft tissue infections: a guide to early diagnosis and initial therapy

Necrotizing skin and soft tissue infections are caused by many different bacteria, are frequently polymicrobial, and may have a deceptively innocent early clinical presentation. Clostridial and nonclostridial necrotizing infections are frequently similar in their early presentation. The initial presentation of these infections can be insidious, which results in delay in diagnosis and the start of therapy. The clinician must use sound medical principles of clinical history and meticulous examination in each patient, combined with constant suspicion, to establish a timely diagnosis. This group of infectious diseases is associated with frequent morbidity and significant mortality rates, which increase with any delay in the diagnosis and the initiation of medical and surgical therapy. Also associated with these necrotizing infections is an excessive index of litigation. This review is intended as a guide for the clinician in making an early diagnosis of any necrotizing skin and soft tissue infection and initiating effective medical and surgical therapy.     

Necrotizing fasciitis: early sonographic diagnosis

Necrotizing fasciitis is a rare, but potentially fatal bacterial infection of the soft tissues. Establishing the diagnosis at the early stages of the disease remains the greatest challenge. We report a case of necrotizing fasciitis involving the upper extremity. Sonography revealed subcutaneous emphysema spreading along the deep fascia, swelling, and increased echogenicity of the overlying fatty tissue with interlacing fluid collections. The patient responded well to early surgical debridement and parenteral antibiotics.     

Modern Concepts of the Diagnosis and Treatment of Necrotizing Fasciitis

Background: Necrotizing fasciitis is a potentially fatal infection involving rapidly progressive, widespread necrosis of the superficial fascia. Objectives: The purpose of this collective review is to review modern concepts of the treatment and diagnosis of necrotizing fasciitis. Discussion: Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and the fascia. Although the pathogenesis of necrotizing fasciitis is still open to speculation, the rapid and destructive clinical course of necrotizing fasciitis is thought to be due to multibacterial symbiosis. During the last two decades, scientists have found that the pathogenesis of necrotizing fasciitis is usually polymicrobial, rather than monomicrobial. Although there has been no published well-controlled, clinical trial comparing the efficacies of various diagnostic imaging modalities in the diagnosis of necrotizing infections, magnetic resonance imaging (MRI) is the preferred technique to detect soft tissue infection. MRI provides unsurpassed soft tissue contrast and spatial resolution, has high sensitivity in detecting soft tissue fluid, and has multiplanar capabilities. Percutaneous needle aspiration followed by prompt Gram's staining and culture for a rapid bacteriologic diagnosis in soft tissue infections is recommended. Surgery complemented by antibiotics is the primary treatment of necrotizing fasciitis. Conclusion: Wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure should be undertaken. Successful use of intravenous immunoglobulin has been reported in the treatment of streptococcal toxic shock syndrome. The use of adjunctive therapies, such as hyperbaric oxygen therapy, for necrotizing fasciitis infection continues to receive much attention.     

腹腔感染致休克患者行损伤控制性治疗的护理

目的探讨腹腔感染导致感染性休克患者行损伤控制性治疗的护理方法。方法回顾性分析并总结2007年12月至2011年1月成都军区总医院普外胃肠科收治的32例腹腔严重感染致休克患者的临床资料。结果经损伤控制性治疗与护理,32例患者中30例患者痊愈出院、2例患者由于多器官功能衰竭死亡。结论腹腔感染导致休克的患者应用损伤控制性策略指导护理可以早期发现休克症状,早期进行抗休克治疗,有效腹腔引流,从而维护重要器官功能、控制感染、促进感染灶的消除,最终降低患者创伤程度、提高救治成功率。     

负压封闭引流技术治疗糖尿病并发坏死性筋膜炎的护理

目的探讨应用负压封闭引流技术(vacuum sealing drainage,VSD)治疗糖尿病并发坏死性筋膜炎的护理。方法对我科收治的13例2型糖尿病并发坏死性筋膜炎患者应用VSD治疗,探讨应用VSD治疗2型糖尿病并发坏死性筋膜炎患者的护理对策及其方法。结果 VSD治疗坏死性筋膜炎创面有较好的效果,可以促进创面肉芽组织生长,防止创面感染加重,减轻创面渗出,创面一期手术植皮均成活。12例患者创面全部愈合后出院;1例患者因坏死性筋膜炎创面较大,治疗过程中因并发大面积脑梗死而病死。结论 VSD治疗糖尿病并发坏死性筋膜炎患者的效果较好,值得推广。     

Dermohypodermites bactériennes nécrosantes et fasciites nécrosantes : chez l’enfant aussi !

Necrotizing soft tissue infection in children with or without necrotizing fasciitis is a rare bacterial infection. Varicella and trauma represent the most frequent predisposing factors. These infections must be early diagnosed, before the occurrence of any complication, including extension necrosis of soft tissue and septic shock. Magnetic resonance imaging and computed tomography-scan are helpful to delimit necrosis extent in deeper tissues. However, indications should be discussed according to infection localisation and imaging timing should not delay appropriate care. Group A β-hemolytic streptococcus is the most common microorganism associated with these infections, although incidence of Staphylococcus aureus is increasing. Death occurs in 5–20% of patients. Good prognosis is related to early diagnosis, antibiotic treatment and surgery. This emergent multidisciplinary approach is sometimes difficult to manage in paediatrics because of the rarity of these infections.     

Necrotizing Soft Tissue Infections: A Review of Diagnosis,Management, and Implications for NP Practice

Skin and soft tissue infections are among the most common diagnoses seen by nurse practitioners practicing in all settings. These infections range from mild, uncomplicated cellulitis to the more severe, complicated diagnosis of necrotizing soft tissue infections (NSTI). For patients presenting with symptoms of skin and soft tissue infections, differentiating NSTIs from less insidious infections is of paramount importance. NSTIs can be difficult to diagnose because the early presentation may be misleadingly straightforward; however, it is essential that NPs carefully consider NSTIs when a patient presents with the following cardinal skin signs: erythema, swelling, and warmth.     

Can Paronychia Cause a Remote Necrotizing Soft Tissue Infection?

Remote necrotizing soft tissue infection (NSTI) resulting from paronychia is very unusual but potentially lethal. We report a case of a 39-year-old woman affected by this unusual infection. The paronychia completely resolved in less than 2 weeks, however, a NSTI involved the right chest and flank and the left thigh. The patient required intensive care and multiple surgical debridements. This recent experience and literature data suggest that paronychia can cause a remote NSTI that can rapidly spread and become life-threatening. Broad spectrum antibiotics and aggressive surgical debridement are essential to a successful outcome.     

创面负压封闭引流技术治疗皮肤软组织缺损的护理体会

目的探讨创面负压封闭引流技术（vacuum sealing drainage,VSD）治疗皮肤软组织缺损的效果及护理措施。方法总结2007年10月至2009年3月采用VSD治疗的38例皮肤软组织缺损患者的临床资料与护理措施。结果 38例患者均愈合良好,无一例发生严重感染或骨髓炎。结论 VSD配合精心护理,有利于皮肤软组织缺损患者更快、更好地康复。