负压封闭引流技术治疗糖尿病并发坏死性筋膜炎的护理

目的探讨应用负压封闭引流技术(vacuum sealing drainage,VSD)治疗糖尿病并发坏死性筋膜炎的护理。方法对我科收治的13例2型糖尿病并发坏死性筋膜炎患者应用VSD治疗,探讨应用VSD治疗2型糖尿病并发坏死性筋膜炎患者的护理对策及其方法。结果 VSD治疗坏死性筋膜炎创面有较好的效果,可以促进创面肉芽组织生长,防止创面感染加重,减轻创面渗出,创面一期手术植皮均成活。12例患者创面全部愈合后出院;1例患者因坏死性筋膜炎创面较大,治疗过程中因并发大面积脑梗死而病死。结论 VSD治疗糖尿病并发坏死性筋膜炎患者的效果较好,值得推广。     

1例双侧颈胸部颌下坏死性筋膜炎的护理体会

目的 探讨双侧颈胸部颌下坏死性筋膜炎的护理对策。方法 对1例双侧颈胸部颌下坏死性筋膜炎患者针对其疾病特点采取多种治疗及护理干预措施。 结果 通过积极治疗和护理干预,患者好转出院。结论 双侧颈胸部颌下坏死性筋膜炎患者病情复杂,病程凶险,针对患者实施的护理措施有效,可以促进患者康复。     

3例颈部急性坏死性筋膜炎病人的护理

[目的]探讨颈部急性坏死性筋膜炎的护理对策。[方法]回顾我科2012年8月—2016年6月3例颈部坏死性筋膜炎病人的临床资料,通过动态干预病人心理、制定有效的综合护理措施后给予疗效评估;加强对本病的认识以及在护理中及时发现病情变化,辅助临床及时作出正确诊断并积极采取治疗措施。[结果]本组3例颈部坏死性筋膜炎病人病情观察及时、护理措施得当、病人配合治疗的依从性良好,均治愈康复出院。[结论]对颈部坏死性筋膜炎病人采取综合性护理措施有利于及时发现病情的变化并促进病人康复。     

糖尿病并发急性坏死性筋膜炎5例护理体会

目的:探讨糖尿病并发急性坏死性筋膜炎的护理方法.方法:对5例糖尿病并发急性坏死性筋膜炎患者密切观察病情和精心护理,包括术前做好心理护理,帮助患者消除紧张、恐惧心理和悲观情绪:进行健康教育和术前准备;术后严密病情观察与监护,通过体温观察判断清创的程度;掌握创面观察指标及特点.及时判断皮下筋膜坏死的范围;防止皮肤、口腔、泌尿系感染;做好换药护理促进创面愈合:对并发症及早抢救与护理.结果:5例均治愈出院.结论:糖尿病并发急性坏死性筋膜炎患者术前、术后严密观察与护理对及时发现病情变化,进行有效的治疗非常重要.     

胆道术后肠瘘胆瘘合并坏死性筋膜炎患者的护理

目的总结胆道术后十二指肠瘘、胆瘘合并右侧胸腹壁坏死性筋膜炎患者的护理方法。方法回顾性分析2012年3月在扬州大学临床医学院普外科治疗的1例胆道术后肠瘘、胆瘘合并坏死性筋膜炎患者的临床资料,并总结其护理措施。结果经治疗,患者恢复全肠内营养,好转出院。结论早期清除坏死性筋膜炎创面,并密切观察创面情况,实施有针对性地护理,能有效促进营养物质的吸收、坏死性筋膜炎的恢复和瘘口的愈合。     

封闭负压引流冲吸法治疗急性坏死性筋膜炎患者的护理

目的 探讨封闭负压引流(VSD)冲吸法治疗急性坏死性筋膜炎患者的护理.方法 对8例急性坏死性筋膜炎患者应用VSD冲吸法治疗,并采取了精心的护理措施(心理支持、局部皮肤准备、饮食指导、用药护理、密切观察负压封闭引流情况及功能锻炼等).结果 8例患者行扩创+VSD负压吸引冲洗时间为7～24 d,未发生并发症,平均住院时间为38 d,均治愈出院.结论 在VSD冲吸法治疗坏死性筋膜炎患者的过程中,耐心细致的护理有助于提高治疗效果,促进创面愈合.     

封闭式负压吸引联合银离子敷料在难愈坏死性筋膜炎创口换药中的应用

目的:探讨封闭式负压吸引联合银离子敷料在难愈坏死性筋膜炎创口换药中的应用方法及效果。方法:将23例急性肛周坏死性筋膜炎患者45处创口随机分为观察组12例24处创口和对照组11例21处创口,对照组采用传统换药方法,观察组采用封闭式负压吸引联合银离子敷料的换药方法,比较两组临床效果。结果:两组患者换药14 d治疗效果、换药疼痛评分、治疗满意度、换药次数、愈合时间比较差异有统计学意义(P0.05)。结论:封闭式负压吸引联合银离子敷料在难愈坏死性筋膜炎创口换药中的应用效果较好,可促进创口愈合。     

房树人绘画测验疗法在一例糖尿病合并坏死性筋膜炎伴重度焦虑患者中的心理干预实践

目的：探讨房树人绘画测验疗法在一例糖尿病合并坏死性筋膜炎伴严重焦虑患者的心理评估与干预效果。方法：在患者治疗前期、中期、后期分别进行焦虑自评（SAS）,并进行房树人绘画测试疗法。结果：在患者治疗前中后期使用焦虑自评量表进行评估,得分依次为：重度焦虑（70分）、中度焦虑（64分）和无焦虑（49分）,三次绘画测试疗法显示患者的焦虑情绪得到了极大的改善。结论：针对该糖尿病合并坏死性筋膜炎伴严重焦虑的患者,房树人绘画测试疗法是一种行之有效的心理评估与干预方法。     

中西医结合治疗肛源性坏死性筋膜炎患者的观察及护理

目的 探讨中西医结合治疗肛源性坏死性筋膜炎的护理经验,以提高护理质量及患者术后生活质量.方法 回顾性分析10例会阴部急性坏死性筋膜炎病例的治疗与护理过程,总结临床护理经验.结果 10例患者均痊愈出院,创面愈合时间为23～72 d,平均45 d,会阴部无组织缺损、瘢痕少,会阴部无功能障碍.结论 肛源性急性坏死性筋膜炎中西医结合治疗,配合积极有效的护理,不仅可以挽救患者的生命,而且可以避免会阴组织缺损、减少瘢痕形成,对于保全患者会阴部组织完整性及患者的性功能具有重要意义.     

湿性愈合模式在肛周脓肿致坏死性筋膜炎患者伤口护理中的应用

目的：探讨湿性愈合模式在肛周脓肿致坏死性筋膜炎患者伤口护理中的应用及效果。方法回顾性分析、总结2010年1月-2013年5月收治的3例肛周脓肿致坏死性筋膜炎患者伤口治疗及护理经验。结果通过开放引流、瘘管科学处理,有效清创、控制感染、防止血流感染,合理固定、提高生活质量,科学营养支持、促进肉芽生长创面愈合,人文关怀、多学科协作促进康复等湿性愈合伤口护理,所有患者均愈合,无病死、致残。结论湿性愈合伤口护理在急性坏死性筋膜炎的创面治疗中可以促进伤口愈合、降低医疗风险,安全可行。     

An unusual complication of missed appendicitis

A case of necrotizing fasciitis complicating missed appendicitis with perforation and abscess formation in a 63-year-old diabetic is presented. The case emphasizes the importance of thorough, conservative evaluation and management in elderly diabetic patients. The ED management of patients with necrotizing fasciitis is also briefly reviewed.     

Burn center management of necrotizing fasciitis

Necrotizing fasciitis is a rapidly progressive soft-tissue infection associated with significant morbidity and mortality. Necrotizing fasciitis is similar to invasive burn wound infection in that diagnosis requires histologic examination of affected tissue and treatment requires aggressive surgical debridement followed by skin autograft. Transfer to a burn center facilitates the management of necrotizing fasciitis, where requisite surgical and nursing expertise is available. We reviewed the experience of one burn center in the management of necrotizing fasciitis over a 5-year period. Ten patients were transferred to the burn center from other medical facilities for care, arriving a mean of 8.9 days after initial hospital admission. The diagnosis was made by a surgical service or consultation before transfer in all cases; initial admission to a medical rather than a surgical service delayed surgery in five cases. All patients had surgical debridement before transfer but required a mean of 5.1 additional operations at the burn center. Although the mean extent of involvement was 14.8% body surface area, the mean length of burn center stay was 34.9 days. Complications were frequent, including pulmonary failure requiring mechanical ventilation (n = 6), renal insufficiency or failure (n = 5), hypotension requiring pressers (n = 4), deep venous thrombosis (n = 3), and pulmonary emboli (n = 1). Overall mortality was 2 of 10 patients (20%). Both fatalities were associated with delay in initial surgical procedure and in transfer to the burn center. The similarity of necrotizing fasciitis and invasive burn wound infection makes the burn center the ideal setting for the treatment of this disease. We advocate the addition of necrotizing fasciitis to the list of conditions currently recognized by the American Burn Association as appropriate for burn center transfer and care.     

Necrotizing fasciitis precipitating diabetic ketoacidotic coma

Necrotizing fasciitis is a rapidly spreading infection of the subcutaneous tissue and fascia; diabetes mellitus appears to be the most frequent underlying disease. Early diagnosis and immediate aggressive surgical therapy are paramount to curtail morbidity and mortality, but diagnosis is often difficult and unnecessarily delayed. We describe a case of necrotizing fasciitis precipitating diabetic ketoacidotic coma where correct diagnosis was not made until the 14th hospital day. We stress the fact that physicians caring for critically ill patients should be keenly aware of the possibility of necrotizing fasciitis when tending diabetic patients with unexplained fever; failure to recognize the disease can have devastating results. Finally, we believe this to be the first reported case of diabetic ketoacidotic coma precipitated by necrotizing fasciitis.     

The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections

OBJECTIVE: Early operative debridement is a major determinant of outcome in necrotizing fasciitis. However, early recognition is difficult clinically. We aimed to develop a novel diagnostic scoring system for distinguishing necrotizing fasciitis from other soft tissue infections based on laboratory tests routinely performed for the evaluation of severe soft tissue infections: the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. DESIGN: Retrospective observational study of patients divided into a developmental cohort (n = 314) and validation cohort (n = 140) SETTING: Two teaching tertiary care hospitals. PATIENTS: One hundred forty-five patients with necrotizing fasciitis and 309 patients with severe cellulitis or abscesses admitted to the participating hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The developmental cohort consisted of 89 consecutive patients admitted for necrotizing fasciitis. Control patients (n = 225) were randomly selected from patients admitted with severe cellulitis or abscesses during the same period. Hematologic and biochemical results done on admission were converted into categorical variables for analysis. Univariate and multivariate logistic regression was used to select significant predictors. Total white cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein were selected. The LRINEC score was constructed by converting into integer the regression coefficients of independently predictive factors in the multiple logistic regression model for diagnosing necrotizing fasciitis. The cutoff value for the LRINEC score was 6 points with a positive predictive value of 92.0% and negative predictive value of 96.0%. Model performance was very good (Hosmer-Lemeshow statistic, p =.910); area under the receiver operating characteristic curve was 0.980 and 0.976 in the developmental and validation cohorts, respectively. CONCLUSIONS: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis. The variables used are routinely measured to assess severe soft tissue infections. Patients with a LRINEC score of > or = 6 should be carefully evaluated for the presence of necrotizing fasciitis.     

Ultrasonographic Screening of Clinically-suspected Necrotizing Fasciitis

OBJECTIVE: To determine the accuracy of ultrasonography for the diagnosis of necrotizing fasciitis. METHODS: This study was a prospective observational review of patients with clinically-suspected necrotizing fasciitis presenting to the emergency department of an urban (Taipei) medical center between October 1996 and May 1998. All patients underwent ultrasonographic examination, with the ultrasonographic diagnosis of necrotizing fasciitis based on the criterion of a diffuse thickening of the subcutaneous tissue accompanied by a layer of fluid accumulation more than 4 millimeters in depth along the deep fascial layer, when compared with the contralateral position on the corresponding normal limb. The final diagnosis of necrotizing fasciitis was determined by pathological findings for patients who underwent fasciotomy or biopsy results for patients managed nonoperatively. RESULTS: Data were collected for 62 patients, of whom 17 (27.4%) were considered to suffer from necrotizing fasciitis. Ultrasonography revealed a sensitivity of 88.2%, a specificity of 93.3%, a positive predictive value of 83.3%, a negative predictive value of 95.4%, and an accuracy of 91.9% as regards the diagnosis of necrotizing fasciitis. CONCLUSIONS: Ultrasonography can provide accurate information for emergency physicians for the diagnosis of necrotizing fasciitis.     

综合足部护理对糖尿病周围神经病变患者预后的影响

目的:探讨综合足部护理对糖尿病周围神经病变(DPN)患者预后的影响。方法:将40例DPN患者随机分为观察组和对照组各20例,两组患者均给予糖尿病饮食并接受我院磁热疗配合电针治疗糖尿病方法,控制血糖配合营养神经、活血化淤类药物等治疗。对照组给予常规护理,观察组实施综合足部护理,周期为3个月。比较两组患者空腹血糖及餐后2 h血糖下降量、临床症状改善情况。结果:观察组空腹血糖及餐后2 h血糖下降量、临床症状改善情况与对照组比较差异有统计学意义(P<0.05)。结论:综合足部护理可改善DPN患者神经传导速度及相关症状,有效预防并发症的发生。