一例粉尘爆炸致特重度烧冲复合伤并发急性肾损伤患者的护理  

Nursing of one patient with extremely severe burn-blast combined injury complicated with acute kidney injury caused by dust explosion

作　　者：姜彬 沈鸣雁[1] 沈涛 Jiang Bin;Shen Mingyan;Shen Tao(Department of Burns,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院烧伤科,杭州310009

出　　处：《中华烧伤杂志》2020年第7期603-605,共3页Chinese Journal of Burns

摘　　要：2018年1月31日,浙江大学医学院附属第二医院收治1例交联聚维酮粉尘爆炸致特重度烧冲复合伤并发急性肾损伤的21岁男性患者。针对患者的病情,落实下列护理措施:烧伤休克期合并急性肾损伤行连续性肾脏替代治疗期间,加强液体出入量管理、防范低体温和非计划下机;针对创伤性气胸做好胸腔闭式引流管护理,实施低潮气量、低呼气末正压的通气策略;感染耐碳青霉烯类抗生素肺炎克雷伯菌期间优化监护室环境消毒、做好多黏菌素B药物护理。经过71 d综合治疗和护理,患者康复出院。本病例提示,针对特重度烧冲复合伤患者的肾功能、肺功能情况,实施个体化治疗和护理措施有助于提高该类患者的治愈率,并改善预后。On January 31,2018,a 21-year-old male patient with extremely severe burn-blast combined injury complicated with acute kidney injury caused by dust explosion of crospovidone was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine.The following nursing measures were carried out,aiming at the condition of the patient.We strengthened the management of fluid intake and output volume,prevented hypothermia and unplanned disembarkation during the period of continuous renal replacement therapy with burn shock and acute kidney injury.For traumatic pneumothorax,we took a good care of the closed chest drainage tube and implemented a ventilation strategy of low tide and low positive end expiratory pressure.During the infection with carbapenem-resistant Klebsiella pneumoniae,the environmental disinfection of the care unit was optimized and polymyxin B drug care was done.After 71 days of comprehensive treatment and nursing care,the patient recovered and was discharged from hospital.This case suggests that,in view of the renal function and lung function of patients with extremely severe burn-blast combined injury,individualized treatment and nursing measures are helpful to improve the cure rate and prognosis.

关 键 词：烧伤 护理 聚维酮 粉尘爆炸 烧冲复合伤 

分 类 号：R644[医药卫生—外科学] R339.3+9[医药卫生—临床医学] R364.5