胰腎同時移植術後傷口周圍潮濕相關性皮膚炎之護理經驗

Nursing Care Experiences of Periwound Moisture-Associated Dermatitis After Simultaneous Pancreas-Kidney Transplantation

胰腎同時移植術為第一型糖尿病合併末期腎衰竭的首選手術治療方式。然而此手術合併症風險高，十二指腸吻合處滲漏為常見合併症之一，嚴重可致胰臟移植失敗。本個案於胰腎同時移植術後出現十二指腸吻合處滲漏之合併症，嚴重滲漏之消化液浸潤傷口及周圍皮膚，導致傷口周圍潮濕相關性皮膚炎。護理期間經由跨領域醫療團隊合作擬定傷口護理處置，個案於轉院前傷口周圍潮濕相關性皮膚炎已獲得痊癒。關於護理臨床實務應用，傷口周圍潮濕相關性皮膚炎及浸潤傷口應共同照護，本文提供以下建議：（1）控制潮濕根源；（2）浸潤傷口使用先進敷料搭配紗布，而感染性傷口使用抗菌含銀敷料；（3）複雜型慢性傷口可考慮負壓傷口療法；（4）傷口周圍皮膚使用中性乾洗潔膚液配合不織布執行清潔，保持皮膚清潔乾燥，搭配無痛保膚膜及人工皮作隔絕保護。期望本個案之護理經驗，能提供同仁未來照護胰腎同時移植術後出現腸吻合滲漏，導致傷口周圍潮濕相關性皮膚炎之護理實務參考。

Simultaneous pancreas-kidney (SPK) transplantation is the primary surgical treatment for type I diabetes mellitus with end-stage renal disease. However, this transplant surgery has a high-risk of surgical complications, including duodenal anastomotic leakage, which may lead to pancreas transplantation failure if the leakage worsens. This case report describes a patient who suffered from duodenal anastomotic leakage after SPK transplantation. The digestive enzymes eroded the wound and skin around the wound, resulting in periwound moisture-associated dermatitis. During the period of nursing care, the wound-care intervention was determined by interdisciplinary cooperation. In our case report, the periwound moisture-associated dermatitis healed completely under inter-hospital care. In clinical nursing practice, periwound moisture-associated dermatitis should be cared in combination with macerated wounds. We suggest the following: (1) control the moisture source; (2) use advanced dressings as the primary dressing with sterile gauze as a secondary dressing and silver antimicrobial dressings for infected wounds; (3) consider using negative pressure wound therapy for complicated chronic wounds; and (4) use a pH-neutral skin cleanser with non-woven gauze to clean the periwound skin and keep the skin clean and dry. Finally, we suggest isolating and protecting the skin with No Sting Barrier Film and a hydrocolloid dressing. We hope this nursing care experiences serves as a reference for the nursing care of periwound moisture-associated dermatitis resulting from duodenal anastomotic leakage during / after SPK transplantation.