摘要
目的探讨罕见非结核分枝杆菌感染伤口的临床特征、诊断和处理方法。方法对2例经细菌学检测确诊的非结核分枝杆菌感染伤口进行评估和分析,结合文献复习,总结临床特征为复杂全层伤口、大量脓性渗液、重度疼痛、引流不畅、持续时间长(≥2个月)、细菌培养阳性率低(≤50%),常伴有免疫力低下,治疗难度大,抗生素治疗和多次手术治疗难以奏效。根据文献复习结果和患者特点制定个体化身心整体干预方案,全身干预重点是心理调适、口入营养、有氧运动、确保良好和充足睡眠以提高免疫功能和降低应激反应,局部干预重点是清创、充分引流、银敷料抗感染结合负压伤口治疗、红外线和红光治疗。动态评价治疗效果和调整方法,直至愈合。愈合后采用电话和微信随访3个月,旨在了解有无复发和功能活动情况。结果 2例均治愈,愈合时间分别为98d和48d。随访3个月时,1例伴有糖尿病的男性患者局部伤口感染复发,再次治疗35d愈合;1例女性患者随访期间无复发,功能活动正常。结论非结核分枝杆菌感染伤口复杂难愈,需要综合干预。个体化身心整体干预结合局部伤口处理能有效治疗此类感染伤口。
Objective To investigate the clinical characteristics, diagnostic and treatment methods of rare nontuberculous mycobacteria infected wounds. Methods The clinical data of two patients with nontuberculous mycobacteria infected wounds confirmed by bacteriological detection was assessed and analyzed. Through literature review, their clinical features were summarized as follows ： complicated full thickness wounds, a large amount of purulent exudates, severe pain,inadequate drainage, long duration （ more than 2 months） ,low positive rate of bacteria culture （ less than 50% ） ,being often accompanied with hypoimmunity,and being hard to be cured by antibiotics and surgery. Individualized systemic nursing care protocols were made depending on the results of literature review and each patient＇s condition. Systemic intervention focused on psychological care,oral nutrition, aerobic exercise and keeping adequate and good sleep so as to enhance immunologic function and reduce stress reaction. Local intervention focused on debridement,adequate drainage, silver dressing combined with negative pressure wound therapy, infrared and red light therapy. Results of each patient were evaluated and regulated dynamically until healed. After healing, each patient was followed up for three months by telephone and WeChat for investigating recurrence and functional recovery. Resuits The healing time of two patients with infected wounds was 98d and 48d,respectively. The male patient with di- abetes mellitus re-occurred an infected wound during the three-month follow up, who was healed after 35d of the second treatment. The female patient did not reoccur and her activity was normal during follow-up. Conclusion Nontuber- culous mycobacteria infected wounds are complicated and hard to be healed,and need systemic intervention. It is effective to use individualized systemic care combined with local wound management for those patients.
作者
蒋琪霞
彭青
JIANG Qi-xia PENG Qing(Outpatient Wound Care Center, Nanjing General Hospital, Nanjing 210002,China)
出处
《创伤外科杂志》
2016年第10期581-584,共4页
Journal of Traumatic Surgery
基金
南京军区科技创新课题(14MS103)
关键词
伤口感染
细菌学
护理
干预
wounds infection
nontuberculous mycobacteria
nursing care
systemic intervention
