总结1例海鱼刺伤感染创伤弧菌致脓毒症休克患者的护理体会。针对该例患者受伤机制特殊、发病急、进展快、病情危重等问题,迅速进行创伤弧菌脓毒症的早期识别及观察,做好预见性抢救准备;做好精细液体复苏与管理,预防脓毒症休克,合理使用抗生素,防止全身及患肢感染加重;加强不同类型的创面护理,密切观察患肢血循环情况,促进创面愈合和肢体功能恢复;同时做好心理支持和营养护理。经过58 d的积极治疗与护理,患者康复出院。随访6个月,一般状况良好,右下肢功能恢复良好,能正常行走。
To summarize the nursing of septic shock caused by vibrio vulnifificus infection in a patient with sea fish puncture. In view of the patient's special mechanism of injury,acute onset,rapid progress of the disease,critical condition and etc.,key points of nursing included early recognition and observation of vibrio vulnificus sepsis and predicted preparation of emergency treatment,fine fluid resuscitation and management to prevent septic shock,reasonable use of antibiotics to prevent infection from worsening,enhanced care of different types of infected wounds and close observation of blood circulation of the affected limb to promote wound healing and the recovery of limb function,psychological support and nutritional nursing at the same time. After 58 days of active treatment and care,the patient recovered and was discharged from the hospital. The patient was followed up for 6 months,she was in good condition,the function of the right lower limb recovered and can walk normally.
[1] 王一梅,熊燕,梁建生,等. 洪涝渍水中检出1株创伤弧菌[J]. 中国卫生检验杂志,2016,26(24):3643-3644.
Wang YM,Xiong Y,Liang JS,et al.A strain of Vibrio vulnificus was detected in waterlogged water[J]. Chin J Health Lab Technol,2016,26(24):3643-3644.
[2] 于明明,张康,王晓威,等. 创伤弧菌致病机制、抗生素耐药及污染现状[J]. 社区医学杂志,2018,16(8):83-86.
Yu MM,Zhang K,Wang XW,et al.Pathogenesis,antibiotic resistance and pollution status of Vibrio vulnificus[J]. J Community Med,2018,16(8):83-86.
[3] 王志刚,邵平扬,吴展. 创伤弧菌的微生物学特征及临床感染特点[J]. 中华临床感染病杂志,2008,1(5):314-317.
Wang ZG,Shao PY,Wu Z.Microbiological characteristics and clinical infection characteristics of Vibrio vulnificus[J]. Chin J Clin Infect Dis,2008,1(5):314-317.
[4] 齐文旗,张斌,郑忠骏,等. 拯救脓毒症运动:2021年国际脓毒症和脓毒性休克管理指南[J]. 中华急诊医学杂志,2021,30(11):1300-1304.
Qi WQ,Zhang B,Zheng ZJ,et al.The Save Sepsis Campaign:2021 international guidelines for the management of sepsis and septic shock[J]. Chin J Emerg Med,2021,30(11):1300-1304.
[5] Huang KC,Weng HH,Yang TY,et al.Distribution of fatal vibrio vulnificus necrotizing skin and soft-tissue infections:a systematic review and meta-analysis[J]. Medicine(Baltimore),2016,95(5):e2627.
[6] 王月琴,冯素文,徐凌燕,等. 晚期妊娠合并李斯特菌感染继发脓毒症患者的护理[J]. 中华急危重症护理杂志,2022,3(4):338-340.
Wang YQ,Feng SW,Xu LY,et al.Nursing of a patient with sepsis secondary to Listeria monocytogenes infection during late pregnancy[J]. Chin J Emerg Crit Care Nurs,2022,3(4):338-340.
[7] 佘劝劝. 脓毒症患者合并急性肾损伤的护理分析[J]. 中国卫生标准管理,2020,11(3):151-153.
She QQ.Nursing analysis of patients with sepsis complicated with acute kidney injury[J]. China Health Stand Manag,2020,11(3):151-153.
[8] 祁芳园,林浙兵,李之诉. 创伤弧菌脓毒症早期连续血液净化技术的应用与护理[J]. 中华临床感染病杂志,2016,9(1):72-74.
Qi FY,Lin ZB,Li ZS.Early application of continuous blood purification and its nursing care in patients with Vibrio;vulnificus-induced sepsis[J]. Chin J Clin Infect Dis,2016,9(1):72-74.
[9] Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Intensive Care Med,2017,43(3):304-377.
[10] Singer M,Deutschman CS,Seymour CW,et al.The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA,2016,315(8):801-810.
[11] 李洁琼,张蜜,韩娟,等. 2018脓毒症管理指南更新解读:护理需要关注的变化[J]. 护士进修杂志,2020,35(20):1879-1882.
Li JQ,Zhang M,Han J,et al.Updated interpretation of sepsis management guidelines 2018:nurses need to pay attention to the changes[J]. J Nurses Train,2020,35(20):1879-1882.
[12] 杨大民,张志,刘昌玲,等. 创伤弧菌感染所致坏死性筋膜炎1例[J]. 川北医学院学报,2022,37(5):672-674.
Yang DM,Zhang Z,Liu CL,et al.A case report of necrotizing fasciitis caused by vibrio vulnificus infection[J]. J Nor Sichuan Med Coll,2022,37(5):672-674.
[13] von Keudell AG,Weaver MJ,Appleton PT,et al. Diagnosis and treatment of acute extremitycompartment syndrome[J]. Lancet,2015,386(10000):1299-1310.
[14] 邓娟,熊杰,王芳,等. 1例右下肢坏死性筋膜炎合并脓毒性休克病人的护理[J]. 全科护理,2018,16(29):3709-3710,3712.
Deng J,Xiong J,Wang F,et al.Nursing care of a patient with necrotizing fasciitis of the right lower limb complicated with septic shock[J]. Chin Gen Pract Nurs,2018,16(29):3709-3710,3712.
[15] 韩遵海,席修明. 人性化关怀在脓毒症并发急性肾损伤病人中的应用价值[J]. 护理研究,2017,31(17):2159-2161.
Han ZH,Xi XM.Application value of humanistic care in patients with sepsis complicated with acute kidney injury[J]. Chin Nurs Res,2017,31(17):2159-2161.
