1例胃癌免疫治療引發(fā)重度DKA伴腸梗阻并發(fā)肺炎的中西醫(yī)結(jié)合護(hù)理體會

）；）；NursingexperienceofintegratedtraditionalChineseandWesternmedicineinacaseofsevereDKAcomplicatedwithintestinalobstructionandpneumoniacausedbyimmunotherapyforgastriccancerLIUYin,HuangJun，QiuMinyan，ZhaoHongxia，ShenXiaoyanDepartmentofIntegratedTraditionalChineseandWesternMedicineOncology,JiangyinClinicalCollege,XuzhouMedicalUniversity,Jiangyin,Jiangsu,214400【Abstract:】:ThispapersummarizedthenursingcontentsofacaseofsevereDKAwithacuteintestinalobstructioncomplicatedwithpneumoniasecondarytogastricadenocarcinomatreatedwithanti-PD-1.Themainpointsofnursingincluded:diseasemonitoring,nauseaandvomitingnursing,lackofknowledgeandothergeneralnursingmeasures.ThekeyanddifficultpointsofnursingforthiscasewerecomplicatedwithobstructionandICPisrelateddiabetes.Therefore,integratedtraditionalChineseandwesternmedicinenursingandcorrespondingnursingmeasuresweretaken.Undertheintegratedmedicalandnursingmodel,aftercarefultreatmentandcare,thepatient'svitalsignsreturnedtonormalafter56daysofhospitalization,andtheirconditionimprovedandtheyweredischarged.Wehavestandardizedthenursingprocessfortreatingacuteepisodesofketoacidosisinourdepartment,accumulatedourexperienceinnursingtumorpatientswithintestinalobstruction,deepenedthespecializedconnotationofintegratedtraditionalChineseandWesternmedicinenursinginourdepartment,andareworthyofclinicalpromotion.【Keywords】:Gastriccancer;Immunecheckpointinhibitors(ICIs);Diabetesketoacidosis(DKA);Intestinalobstruction;IntegratedTraditionalChineseandWesternMedicineNursing;Individualcases;患者，謝某，男，55歲，小學(xué)文化，B型（Rh陽性）血，2023年2月272022-2-27測得葡萄糖26.0mmol/L，pH酸堿度7.05，實(shí)際碳酸氫根3.0mmol/L考慮DKA，立即住院治療。入院后遵醫(yī)囑予積極補(bǔ)液2022-3-5患者乏力惡心嘔吐加重，予“腸粘連方”中藥熏蒸治療，抑酸護(hù)2022-4-13查CT肺部炎癥明顯吸收，口服莫西沙星抗感染治療，肛門排便在發(fā)生壓力性損傷的風(fēng)險；Morse跌倒風(fēng)險評分60分提示患者為跌倒高危應(yīng)該化中醫(yī)特色治療，醫(yī)生根據(jù)癥狀進(jìn)行辯證分型，護(hù)士序漸進(jìn)，家屬共同參與；為其創(chuàng)造安靜適宜的病室心理護(hù)理：由于患者長期惡心、嘔吐、消瘦乏力,加之長期遭受癌性疼立良好的護(hù)患關(guān)系，增加患者對醫(yī)護(hù)人員的信任感；多與患者交流,傾聽患者的內(nèi)心及訴求；對患者進(jìn)行正向的支持與鼓勵,緩解患者焦慮、抑郁等負(fù)性情緒。調(diào)節(jié)臟腑功能[9]協(xié)助患者取舒適體位，充分暴露腹部，注意保暖，必要時遮擋將預(yù)熱時調(diào)節(jié)出氣口與熏蒸部位的距離為30cm，熏蒸過程中5-15min巡視一次，關(guān)注患者主訴及局部皮膚情況；③針刺足三里：足三里穴為足陽明胃經(jīng)合穴,該本例患者服用PD-1后并發(fā)DKA，經(jīng)討論采取以下護(hù)理措施：①病情監(jiān)測：n評分分焦慮3534653434123401反應(yīng)的評價標(biāo)準(zhǔn)：其中惡心程度0度表示無惡心，Ⅴ度表示死亡；嘔吐程度0大便不暢0分表示正常，6分表示重度，大便明顯不暢；腹脹0分表示正常，666664666266424422220可出現(xiàn)酮體增多，動脈血pH值下降，白細(xì)胞升高等[14]。胰島素及C肽水平?？靃1]李海強(qiáng),蔣小華.胃癌新輔助治療的研究進(jìn)展[J].臨床腫瘤學(xué)雜志,2020,25(01):75-80.[2]藍(lán)清華,曾慶芳,詹濤,等.抗PD-1免疫治療聯(lián)合放療在鼻咽癌患者中的應(yīng)用效果及對腫瘤標(biāo)志物的影響[J].中國醫(yī)學(xué)創(chuàng)新,2022,19(27):1-5.[3]GalliganA,XuW,FourlanosS,etal.Diabetesassociatedwithimmunecheckpointinhibition:presentationandmanagementchallenges[J].DiabetMed,2018.DOI:10.[4]WrightJJ,SalemJE,JohnsonDB,etal.IncreasedReportingofImmuneCheckpointInhibitor-AssociatedDiabetes[J].DiabetesCare,2018,41(12):e150-e151.DOI:10.2337/dc18-1465.[5]張淼.晚期消化道惡性腫瘤并發(fā)難治性腸梗阻患者的護(hù)理[J].中國腫瘤臨床與康復(fù),2013,20(02):187-188.DOI:10.13455/ki.cjcor.2013.02.001.[6]史娟英,高娟.胃癌術(shù)后化療間歇期并發(fā)腸梗阻患者的護(hù)理體會[J].實(shí)用臨床護(hù)理學(xué)電子雜志,2019,4(31):54.2019,48(06):727-728.[8]李曉華,李軍,李潔.便秘推拿聯(lián)合穴位按摩對老年氣虛血瘀證胸痹合并便秘患者護(hù)理觀察[J].四川中醫(yī),2022,40(04):208-211.[9]劉鵬,彭昭文,尤海玲,等.基于多模式理念的中醫(yī)外治惡性腸梗阻的思路探討[J].上海中醫(yī)藥雜志,2020,54(10):16-19.DOI:10.16305/j.1007-1334.2020.2001107.[10]羅堅(jiān)女,金國軍.足三里穴位按摩對腹部手術(shù)后腸功能恢復(fù)的療效觀察[J].中華中醫(yī)藥雜志,2020,35(03):1611-1612.[11]程鈺,王芳,朱世杰,等.中醫(yī)外治法在惡性腸梗阻治療中的研究進(jìn)展[J].河南中醫(yī),2019,39(10):1608-1611.DOI:10.16367/j.issn.1003-5028.2019.10.0396.[12]國春花,雷敏,柴文茹,等.改良深度灌腸在神經(jīng)源性腸道功能障礙患者中的應(yīng)用效果[J].中華現(xiàn)代護(hù)理雜志,2018(36):4405-4407.[13]ClotmanK,JanssensK,SpecenierP,etal.ProgrammedCellDeath-1Inhibitor-InducedType1DiabetesMellitus[J].J