1例糖尿病患者颈部慢性溃疡伴高渗高血糖综合征的护理

Nursing care of a diabetic patient with chronic neck ulcer accompanied by hyperosmolar hyperglycemia syndrome combined with septic shock

总结1例糖尿病颈部慢性溃疡伴高渗高血糖综合征合并感染性休克患者的护理经验。护理要点:术前进行早期感染性休克集束化管理,精准化容量控制,纠正高渗高血糖,抗凝管理、预防血栓形成,同时关注创面渗血、渗液;术后建立多学科创面管理团队,加强体位管理,预防器械相关压力性损伤的发生;给予早期营养支持,早期活动与心理支持,加速患者的康复。经多学科合作治疗和精心护理,患者入院15 d拔除气管插管,生命体征平稳,血糖值正常,创面由黄黑色转为红色,无严重并发症发生,营养状况良好,入院16 d转至普通病房,26 d出院。出院后随访3个月伤口愈合良好,颈部皮肤完整,无不适症状。

To summarize the nursing care experience for a patient with diabetic chronic neck ulcer with hyperosmolar hyperglycemia syndrome combined with septic shock.Key points of nursing care include:preoperative bundle management of early septic shock,precise liquid control,correction of hypertonic and hyperglycemia levels,anticoagulant management to prevent thrombosis,and management of wound bleeding and exudation to win the opportunity for surgical treatment.A multidisciplinary wound management team was established after surgery to focus on postural management and prevent the occurrence of device-related pressure injuries.Early nutrition support,early mobilization and psychological support were given during hospitalization to accelerate the patient’s recovery.After multidisciplinary treatment and nursing care,the patient’s endotracheal intubation was removed 15 days after admission,vital signs were stable,and blood glucose level became normal.The wound surface changed from yellow and black to red,and tended to heal.No serious complications occurred,and the patient was in good nutrition status.The patient was transferred to the general ward 16 days after admission and discharged 26 days after admission.3 months follow-up after discharge showed that the wound was healed,the neck skin was intact,and there were no other symptoms of discomfort.