中毒性表皮坏死松解症的护理

Nursing of patients with toxic epidermal necrolysis

目的总结中毒性表皮坏死松解症(toxic epidermal necrolysis,TEN)的护理要点。方法对10例TEN患者在常规治疗基础上对皮损进行整体评估,对于红斑松弛皮肤、水疱未破皮损给予复方氧化锌滑石粉外涂以促进皮损干性剥脱,对于糜烂渗出皮损应用红外线照射及美宝湿润烧伤膏油纱外敷利于皮损湿性愈合;并同时做好特殊部位的黏膜护理;加强保护性隔离,减少患者继发感染;密切观察患者病情变化情况;做好饮食指导。结果 10例患者干性剥脱面积30~60%,剥脱时间5~9 d,平均(7.20±1.69)d;皮损糜烂面积10%~60%,皮损愈合时间7~18 d,平均(13.70±3.40)d。结论依据TEN患者具体情况,给予针对性的治疗护理,能促进皮损干性剥脱,减少皮损糜烂面积,减轻患者痛苦,促进皮损修复。

Objective To summarize the main nursing points of toxic epidermal necrolysis. Methods On the foundation of conventional therapy, an overall assessment was carried out among 10 patients with toxic epidermal necrolysis. On loose skin with erythema, a combination of zinc oxide and talcum powder was externally applied to skin lesions where blisters were not broken in order to promote dry-style exfoliation of the skin lesion. After infrared irradiation, gauze containing MEBO was applied externally to skin lesions with eroded secretions to moisturize them, thus facilitating healing of the skin lesion. Meanwhile, mucosa of special part of patient＇s body was well nursed. Protective isolation was enhanced in order to reduce secondary infection. The patient＇s conditions were observed closely. Diet guidance was also done. Results All the patients were dry-style exfoliated with treatment ranges reaching up to 30%to 60%of the affected area. Dry-style exfoliation time was between 5 to 10 days, with an average of 7.20 ±1.69 days. The area of skin lesion erosion ranged from 10% to 60%. Following the external application of MEBO gauze to moisturize and heal, skin lesion healing time ranged from 7 to 18 days with an average of 13.70 ±3.40 days. Conclusion According to the specific situation of toxic epidermal necrolysis, targeted nursing and treatment can promote the dry-style exfoliation of skin lesions, reduce the area of skin erosions, alleviate the suffering of patients and promote healing of the skin lesion.