骨髓移植术后并发粟粒型肺结核及带状疱疹一例的护理特征  

Nursing characteristics of one patient with miliary tuberculosis and herpes zoster after bone marrow transplantation

作　　者：郭影[1] 王琳[1] 

机构地区：[1]同济大学附属上海市肺科医院结核一科,200433

出　　处：《中国防痨杂志》2017年第4期424-427,共4页Chinese Journal of Antituberculosis

摘　　要：2016年8月在同济大学附属上海市肺科医院结核一科收治了1例18岁女性骨髓移植术后并发粟粒型肺结核及带状疱疹的患者，对该患者在住院期间实施了呼吸道保护性隔离措施，对容易发生感染的疱疹创面及静脉输液用经外周静脉置入中心静脉导管（peripherally inserted central catheter，PICC）管路加强了皮肤护理和局部保护。在使用抗结核、抗病毒、免疫抑制及糖皮质激素等多种药物治疗时，做到按时按量给予；同时合理安排使用顺序，避免药物间及药物与食物间的相互影响，并做好药物不良反应的监测，一旦出现及时处理。给予多种镇痛措施和降温退热护理，结合患者的营养状况及病情进行饮食指导，针对患者年纪轻、病程长、病情重的特点，对患者实施个性化心理护理，并在患者出院前进行康复指导。患者共住院25d，病情好转而出院。骨髓移植术后并发粟粒型肺结核及带状疱疹的患者，病情复杂，治疗时间长，应采取有效防护措施防止感染发生而加重病情，多种药物同时治疗时，做好药物的管理及监测，避免严重不良反应的发生，及时处理发热、疼痛等疾病症状，同时提供针对性的心理支持及康复指导，提高患者生存质量。In August 2016, one patient, who was an 18-year-old woman and got miliary tuberculosis （TB） and herpes zoster （HZ） after the bone marrow transplantation, hospitalized at the 1st TB Department of Shanghai Pulmonary Hospital, Tongji University. During the patient stayed at the hospital, the isolation measures for pre- venting transmission of TB were adopted; the skin nursing and skin protection measures for prevention of infections at the sites of HZ or through the routes of peripherally inserted central catheter （PICC） were strengthened. All the drugs for anti-TB treatment, antiviral treatment, immunosuppressive and glucocorticoid therapies were given to the patient on schedule and with correct doses; at the same time, the administration order of the drugs was properly arranged to avoid the drug-drug interactions and the influence of drug and food. The adverse drug reactions monitoring was conducted during the treatment. The symptomatic treatment and nursing, such as reducing the body tempera- ture, giving diet guide according to the patient＇s nutritional status and the progress of the diseases, were provided; according to the patient＇s age （young girl）, her longer course of disease and severe illness, the individual psycholo- gical nursing and rehabilitation guidance were given to the patient before she was discharge from the hospital. The patient stayed at the hospital for 25 days, and was discharged when her condition was improved. The patient with miliary TB and herpes zoster who received bone marrow transplantation is usually in an complex condition and needs longer duration of treatment, so the effective measures for prevention of infections should be taken to avoid aggra- vating illness; the treatment with multiple drugs at the same time are necessary, so the management and monitoring of the use of those treatment drugs are very important to avoid the serious adverse reaction; symptomatic treatment should be provided, such as dealing with fever, pain and other symptoms, while the psychol

关 键 词：骨髓移植 手术后并发症 结核 粟粒性 疱疹 带状 护理过程 

分 类 号：R521.3[医药卫生—内科学]