多发性骨髓瘤合并IAD 1例的护理并文献复习

Nursing care for a multiple myeloma patient with incontinence-associated dermatitis: case report and literature review

目的探讨多发性骨髓瘤合并失禁相关性皮炎(incontinence associated dermatitis,IAD)的护理。方法总结1例晚期多发性骨髓瘤合并IAD患者的临床表现、诊断、治疗及护理,并进行相关文献复习。结果患者,男,35岁,因"胸背部疼痛10 d,并双下肢感觉活动障碍4 d"入院。入院后诊断为多发性骨髓瘤,呼吸肌麻痹,双侧胸腔积液,阴囊部IAD(中度);予以硼替佐米2 mg、d1、d4、d8、d11+脂质体多柔比星40 mg,d1方案联合化疗及输血、补蛋白、抗感染等对症治疗;应用吸收性产品,及时清理污染皮肤;优选三合一护理巾或透明保护膜等优势产品并定期评估,患者好转出院。结论针对性地为患者提供个体化护理方案,可以降低IAD的发生和提高护理效果。

Objective To investigate nursing methods for treating a multiple myeloma patient with incontinence-associated dermatitis （IAD）. Methods Clinical features, diagnosis,treatment and nursing interventions were described for a patient with advanced multiple myeloma and IAD. The relevant literature was also searched. Results The patient was a 35-year-old male who complained of chest pain for 10 days and double lower limb sensory disturbance for 4 days. After admission,he was diagnosed with multiple myeloma, respiratory muscle paralysis,bilateral pleural effusion, and moderate scrotal IAD. The patient was given combined chemotherapy involving bortezomib （2 mg,d1,4,8,11 ） and liposomal doxorubicin （40 mg d 1 ） as well as other symptomatic treatments,such as blood transfusion,protein supplements,and anti-infectives. Absorbent products were applied to clean up skin contamination quickly. The skin was cleaned, moisturized and protected;3-in-1 care wipes or transparent protective film was used. The patient improved upon discharge. Conclusion Individualized care can reduce the incidence of IAD and improve the efficacy of nursing interventions.