Nursing strategy for a case of hemodialysis complicated with diabetes with skin necrosis caused by 50% glucose injection extravasation
一例血液透析合并糖尿病患者输注50%葡萄糖注射液外渗致皮肤坏死的护理对策

摘要

目的 探讨血液透析合并糖尿病患者输注高渗50%葡萄糖注射液发生外渗致皮肤坏死的临床特点及护理干预措施。方法 回顾性分析1例维持性血液透析合并糖尿病患者因输注50%葡萄糖注射液外渗导致左上肢肿胀、水泡形成及皮肤坏死的临床资料，总结多学科协作下的综合护理措施。结果 经停止输液、局部清创、生长因子凝胶联合水胶体敷料应用等干预后，创面于9天内完全愈合，肢体功能恢复正常，无后遗症发生，随访3个月创面愈合良好。结论 血液透析合并糖尿病患者血管条件差、修复能力弱，输注50%葡萄糖等高渗药物时外渗风险极高，需优先选择透析管路补液；外渗后及时采取阶梯式伤口护理及多维度综合干预，可有效促进创面愈合，改善患者预后。

Abstract

Objective To explore the clinical characteristics and nursing intervention measures of skin necrosis caused by extravasation of hypertonic 50% glucose injection in hemodialysis patients with diabetes.
Methods The clinical data of a maintenance hemodialysis patient with diabetes who suffered from left upper limb swelling, blister formation and skin necrosis due to 50% glucose injection extravasation were retrospectively analyzed, and the comprehensive nursing measures under multidisciplinary cooperation were summarized.
Results After stopping infusion, local debridement, and application of growth factor gel combined with hydrocolloid dressing, the wound healed completely within 9 days, limb function returned to normal, no sequelae occurred, and the wound healed well after 3 months of follow-up.
Conclusion   Hemodialysis patients with diabetes have poor vascular conditions and weak repair ability, and the risk of extravasation is very high when hypertonic drugs such as 50% glucose are infused, so dialysis pipelines should be preferred for fluid replacement; Timely adoption of tiered wound care and multidimensional comprehensive intervention after extravasation can effectively promote wound healing and improve patient prognosis.