使用Glutamine治療於毒性表皮壞死溶解症患者之 實證照護

Using Glutamine Therapy in a Patient with Toxic Epidermal Necrolysis: Evidence-Based Care Experience

毒性表皮壞死溶解症是由史帝芬強生症候群惡化 演變而成，會造成皮膚黏膜大面積破損，並影 響多個器官，主要原因為藥物過敏。本文描述一 位62歲女性因急性腎盂腎炎服用藥物，造成藥 物過敏，引發毒性表皮壞死溶解症，而產生皮膚 完整性受損及急性疼痛等問題甚或到生命危象。筆者身為內科加護病房專科護理師，臨床任務 是與醫師提供ICU重症病人連續性及整合的護理 與醫療照護，透過實證方式找尋相關文獻，發 現Glutamine有助於病人皮膚修復，在與醫療團 隊、病人及家屬討論後，給予病人Glutamine補 充營養及Aquacel Ag敷料換藥，病人疼痛指數大 幅降低、皮膚受損範圍也由體表面積近30%降 至10%以下，並無感染徵象。筆者於此個案照 護過程，運用專業知識提供直接照護及藉由主動 關懷、與聽，適時給予心理支持並與個案建立 良好的護病關係，隨時注意個案生理變化與舒適 狀況，終改善個案症狀。期望此重症臨床護理經驗，可供相關案例之臨床照護參考

 

Toxic epidermal necrolysis is the deterioration of Stevens-Johnson Syndrome, resulting in extensive skin, mucous membranes damage and influences of many organs. It is majorly caused by the drug allergies. This article described a 62-year-old woman who took medicine for flu but subsequently developed a toxic epidermal necrolysis due to drug allergy, resulting in life crisis, impaired skin integrity, and acute pain. The author is a nurse practitioner in the medical intensive care unit clinically working with the physicians to provide ICU patients with continuous and integrated medical care. Glutamine could help the repairment of skin has been fund in the evidence-based literature. After discussing with the medical teams, patients, and families, Glutamine Therapy and Aquacel Ag dressings for wound care were applied to this patient. Then, the pain scores and range of skin damage were greatly reduced, from 30% to less than 10%, and without any sign of infection. During the care process, the author paid intensive attention to the physiological changes of patients and used professional knowledge to provide direct care for improving the patient’s symptoms. The author also actively cared, listened, and provided sufficient psychological support to the patient, and noticed any psychological changes of patient. The author also established a good relationship with the patient. The author expects that this ICU nursing care experience can provide a reference to relevant clinical care