非结核型分枝杆菌感染患者31例护理管理的的体会.docVIP

非结核型分枝杆菌感染患者31例护理管理的的体会 　　doi：10.3969/j.issn.1007-614x.2014.3.74 　　摘 要 目的：提高非结核分枝杆菌感染患者的护理管理水平。方法：收治非结核分枝杆菌感染患者31例，对他们的临床表现、诊治、护理过程及效果进行回顾分析。结果：非结核型分枝杆菌感染患者对大多数抗结核药物呈原始耐药，治疗困难，误诊误治多，龟分枝杆菌对克拉霉素、丁胺卡那霉素最为敏感。结论：对久治不愈或反复发作的脓肿患者需提高警惕性，及时行分枝杆菌的菌型鉴定及药敏测定，以免延误了非结核型分枝杆菌感染的诊断和治疗；并提出非结核型分枝杆菌感染患者管理及护理的操作要点。 　　关键词 非结核分枝杆菌 创面感染 护理 管理 　　Nursing experience of non tuberculosis mycobacterium infection in 31 cases 　　Qu Yan，Yu Weijun，Chen Ying 　　Department of nursing of Yingkou Central Hospital of Liaoning Province，115003 　　Abstract Objective：To improve the level of nursing care of the patients with non tuberculosis mycobacterium infection.Methods：The clinical manifestation， diagnosis and treatment，nursing process and effects of 31 patients infected with Mycobacterium non tuberculosis were retrospectively analyzed.Non tuberculosis mycobacterium infection in patients was the original drug resistance with the most anti tuberculosis drugs，and its treatment was difficult with more erroneous diagnosis and treatment.Mycobacterium chelonei was the most sensitive to clarithromycin and amikacin.Conclusion：We need to be wary of the patients with persistent or recurrent abscess and determine the types of mycobacteria and drug sensitivity promptly，so as not to delay the diagnosis and treatment of non tuberculosis mycobacterium infection.We put forward the key points of management and nursing care of patients with non tuberculous mycobacterial infection. 　　Key words Non tuberculosis mycobacterium；Wound infection；Nursing；Management 　　非结核型分枝杆菌（NTM）引起的感染近年有增加趋势，2002年10月-2012年1月陆续接诊31例患者，现根据患者的发病特点及护理做回顾性分析。 　　资料与方法 　　本组患者31例，男10例，女21例。38个感染部位，臀部25个，面部5个，下肢4个，乳腺3个，腰部1个。肌肉注射引起感染31个部位，针灸引起感染3个部位，假体置入后乳腺感染3个部位，无明确原因感染2个部位。年龄22个月～69岁，平均25岁；住院治疗20例，门诊11例。菌培养快速生长型非结核性分枝杆菌龟分子型8例，脓肿型2例。普通菌培养15例，无细菌生长5例，异形构枸橼酸杆菌3例，金黄色葡萄球菌2例，表皮葡萄球菌2例，铜绿假单胞菌1例，洋葱假单胞菌1例，大肠埃希氏菌1例。 　　治疗方法：门诊10例患者，3例患者臀部有创面，采用普通换药，创面愈合。住院21例患者，其中16例患者应用丁胺卡那、克林霉素抗炎治疗1个月后，14岁以下儿童口服大环内酯类抗生素；14岁以上儿童及成年人给予敏感抗结核药物或喹诺酮类抗生素口服。后期陆续收治的6例患者均予以丁胺卡那静点