1例颅脑损伤合并老年性紫癜患者的皮肤护理

Skin care of a case of craniocerebral injury complicated with senile purpura

目的分析老年性紫癜的临床症状及护理方法,探讨中型颅脑损伤合并老年性紫癜的护理体会。方法天津市环湖医院颅脑损伤抢救中心于2020年3月11日收治1例中型颅脑损伤患者,在入院后发生了老年性紫癜,现对其临床资料进行分析。患者年龄大,颅脑损伤后意识昏睡,处于谵妄状态,躁动剧烈,患者在临床治疗过程中,在给予拔针后出现暗红色瘀斑,受约束的双手腕部,在不到24 h的情况下出现皮肤表皮破损,整个手臂可见散在大片状形态不一的暗红或紫色瘀斑,右胸前壁处可见片状青紫色瘀斑,老年性紫癜患者的血管脆性增加,当皮肤受到轻微的外伤,例如在静脉治疗过程中,扎止血带或者静脉穿刺都易引起皮下出血。结果患者经过"消毒、银离子藻酸盐抗菌及重组牛碱性成纤维细胞成长因子喷洒创面"等及时处理后,患者双手腕部伤口明显好转。经过脱水药,改善脑代谢治疗后患者脑部出血得到吸收,目前处于好转康复阶段。结论该病例提示我们入院时对老年患者应采用束臂试验,对于束臂试验阳性的老年患者要尽量避免约束带等的使用,以降低意外事件发生率,提高护理效果。

Objective To analyze the clinical symptoms and nursing methods of senile purpura,and to explore the nursing experience of middle-sized craniocerbral injury combined with senile purpura.Methods A middle-sized craniocerebral injury patient was admitted to Department of Brain Injury Rescue Center in Tianjin Huanhu Hospital in March 11,2020. The patient developed senile purpura after admission,and the clinical data were analyzed. The patient was old,drowsy,delirium and restless after craniocerebral injury. During the clinical treatment,dark red ecchymosis appeared after the needle was pulled out,and the skin epidermis of the constrained wrists was damaged in less than 24 hours,large dark red or purple ecchymosis with different shapes could be seen in the whole arm,and blue purple ecchymosis could be seen in the front wall of the right chest. The blood vessel fragility of patients with senile purpura increased. When the skin was slightly injured,such as in the process of intravenous therapy,tourniquet or venous puncture were easy to cause subcutaneous bleeding. Results After the timely treatment of "disinfection,silver ion alginate antibacterial and recombinant bovine basic fibroblast growth factor spraying wound",the wound on both wrists of the patient was significantly improved. After the treatment of dehydration drugs and improving brain metabolism,the cerebral hemorrhage of the patient was absorbed and was in the stage of improvement and rehabilitation. Conclusion This case suggested that the bundle arm test should be used for the elderly patients when they are admitted to hospital,and the restraint belt should be avoided for the elderly patients with positive bundle arm test,so as to reduce the incidence of accidents and improve the nursing effect.