总结1例获得性易栓症合并全身多发皮损患者的症状管理体会。针对患者反复血栓形成和多处皮损迁延不愈且不断进展的问题,采取评估—解释—管理—监测—关注细节模式进行症状管理。评估引起反复血栓与皮损的多重病因,包括原发疾病、抗凝不足、深静脉血栓并发症等。根据评估结果进行病因治疗,调整抗凝药物并监测抗凝效果及不良反应,预警肺栓塞的发生,伤口中心会诊处理复杂皮损问题。鼓励患者及家属参与医疗护理决策,提高对治疗护理的依从性。经过23 d的精心治疗与护理,患者血红蛋白、D-二聚体等各项指标趋于正常,血栓未继续进展,全身皮损有效控制后顺利出院。
Experiences in symptom management of a patient with acquired thrombophilia and multiple skin lesions were summarized. In response to the patient's recurrent thrombosis and multiple skin lesions that had been prolonged and progressive,the EEMMA（evaluation,explanation,management,monitoring and attention to detail） model was adopted for symptom management. Multiple causes of recurrent thrombosis and skin lesions were assessed,including the primary disease,insufficient anticoagulation,and the complications of deep vein thrombosis. Following the evaluation results,the primary disease was treated; the anticoagulants were adjusted,and the effects and adverse reactions of anticoagulation were monitored; the occurrence of pulmonary embolism was warned early; the wound center was invited to deal with complex skin lesions. The patient and her family were encouraged to participate in medical care decision-making,thus improving their compliance with care. After meticulous treatment and care for 23 days,the patient's hemoglobin,D-dimer and other indicators tended to be normal,the thrombosis stopped progressing,and the skin lesions were effectively controlled before discharge.
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