1例面部鳞癌高龄糖尿病患者综合治疗并发多种皮肤反应的护理★

Nursing care of an elderly diabetic patient with facial squamous carcinoma complicated by multiple skin reactions after comprehensive treatment★

摘要:

总结1例面部鳞癌高龄糖尿病患者综合治疗并发多种皮肤反应的护理经验。皮肤护理要点：综合评估患者放疗进程、用药时机、皮损表现等，鉴别皮肤损伤类型和程度。对于放射性皮炎，通过基础预防保护、焦痂软化清创、药物喷洒修复、点状敷料拼接及塑形包扎固定等措施，促进创面愈合；对于癌性伤口，通过伤口冲淋、坏死组织排液减张、瘘道有效引流及周围皮肤保护等方法，实现对癌性伤口四大核心症状——疼痛、渗液、出血、恶臭的有效管理；对于皮肤毒性反应，通过水疱处理、创面湿敷、药物喷涂及敷料包扎等措施，促进皮肤愈合。黏膜护理要点：对口腔使用负压冲洗式海绵刷及药物含漱，保持口腔清洁预防感染，并喷涂细胞刺激因子，促进口腔黏膜再生；冲洗眼部及周围分泌物，并使用眼膏及凡士林纱布等对结膜进行保湿，预防溃疡。全身支持护理要点：有效预防感染和镇痛、合理营养支持控制血糖、观察激素治疗不良反应、调动家庭资源做好心理支持。患者住院38 d后顺利出院，出院后1周、1个月、3个月、6个月随访显示，局部及全身皮肤恢复良好，体重及营养指标维持正常。

Abstract:

To summarize the nursing experience of an elderly diabetic patient with facial squamous carcinoma complicated by multiple skin reactions after comprehensive treatment. Key points of skin care: comprehensively evaluate the process of radiotherapy, the timing of medication, and the manifestations of skin lesions, and identify the type and degree of skin damage. For radiation dermatitis, basic prevention and protection, eschar softening and debridement, drug spraying repair, dot dressing stitching, shaping bandaging and fixation are used to promote wound healing. For cancerous wounds, the four core symptoms of cancerous wounds, including pain, exudation, bleeding, and malodor, are effectively managed through wound flushing, drainage of necrotic tissue to reduce tension, effective drainage of fistula, and protection of surrounding skin. For skin toxic reaction, blister treatment, wound wet compress, drug spray, dressing and other measures are used to promote skin healing. Key points of mucosal care: use negative pressure sponge brush and medication to keep the oral cavity clean and prevent infection, spray cell stimulating factor to promote the regeneration of oral mucosa, rinse the eye and surrounding secretions, and use ophthalmic ointment and vaseline gauze to moisturize the conjunctiva as to prevent ulceration. Key points of systemic support care: effective prevention of infection and analgesia, reasonable nutritional support to control blood glucose, observation of the adverse effects of hormone therapy, mobilization of family resources to provide psychological support. The patient was successfully discharged from the hospital after 38 days of hospitalization. The follow-up of 1 week, 1 month, 3 months, and 6 months after discharge showed that the local and systemic skin recovered well, and the body weight and nutritional indicators remained normal.