4086例狂犬病暴露后预防处置及护理干预

Rabies post-exposure prophylaxis and nursing intervention: a report of 4086 cases

目的探讨狂犬病暴露后预防处置及护理干预效果,为有效预防和控制狂犬病的发生提供依据。方法对2011年1月—2013年1月收治的4086例狂犬病暴露者及时进行规范伤口冲洗、消毒、清创;采取狂犬病疫苗五针接种免疫程序(0 d,3 d,7 d,14 d,28 d各接种1剂),儿童与成人剂量相同;进行疫苗的不良反应护理,优质的心理护理和立体式卫生健康宣教,对暴露者临床资料进行回顾性分析。结果本组全程完成狂犬病疫苗接种3964例(97%),局部和全身不良反应44例(1.1%),未出现严重不良反应病例,第一年随访2860例,第二年随访1226例,均无狂犬病病例发生。结论狂犬病暴露后按规范处理伤口,加强对疫苗接种及疫苗不良反应的护理,消除不良心理因素的影响,以强化暴露者接种狂犬疫苗的依从性,从而提高狂犬疫苗接种率和完成率,极大程度地减少狂犬病的发生。

Objective To discuss the effect of protocol for rabies post-exposure prophylaxis and nursing intervention, and provide basis for the effective prevention and control of rabies. Methods 4086 cases exposure to rabies from Jan 2011 to Jan 2013 were collected. They received timely washing, disinfection and debridement, and vaccination （vaccinated at 0 d, 3 d,7 d, 14 d, 28 d）, with the same dose in children and adults. The nursing intervention for the vaccine adverse reactions and mentality, and overallhealth education were conducted in all patients. Their clinical data were reviewed retrospective- ly. Results 97% of them （3964 cases）werevaccinatedfor rabies,44 cases （ 1.1% ） were with local or systemic adverse effects,no severe side effect was found. The follow-up for 2 years showed that none of them were infected by rabi- es. Conclusion The standard clinical disposal, timely vaccination, carefully nursing intervention for the vaccine adverse reactions and mentality will enhance the patients compliance with vaccination, increase the inoculation rate and completion rate, reduce the incidence of rabies.