牙签刺伤致啮蚀艾肯菌合并骨感染1例护理 体会

Nursing Experience of One Case with Bone Infection Complicated by Eikenella corrodens Infection Induced by Toothpick Puncture Injury

摘要: 目的：总结牙签刺伤引发啮蚀艾肯菌感染合并骨感染患者的临床护理要点与实践经验，提升临床对罕见致病菌所致严重手外伤感染的识别与护理能力。方法：对1例57岁女性牙签刺伤右手拇指后继发啮蚀艾肯菌感染、化脓性腱鞘炎、化脓性关节炎及骨髓炎患者，围绕感染控制、疼痛管理、皮瓣血运监测、营养支持、心理干预、血压管理、康复训练及并发症预防实施全程精细化护理，并联合临床药学、康复科、高压氧科、消化科开展多学科协作干预。结果：患者先后接受7次手术治疗，经54天系统护理，感染得到有效控制，创面完全愈合，右手拇指功能逐步恢复，疼痛、焦虑、低蛋白血症、低钾血症等问题显著改善，未发生血管危象、深静脉血栓、肺部感染、脑出血等并发症，康复出院。结论：啮蚀艾肯菌感染培养困难、易漏诊、病程迁延，早期明确诊断、精准抗感染治疗联合多学科协作与系统化整体护理，可有效控制感染进展、降低并发症风险、促进创面愈合与肢体功能恢复，对改善患者预后具有重要意义。

Abstract: Objective: To summarize the key clinical nursing points and practical experience of a patient with Eikenella corrodens infection combined with bone infection caused by toothpick stab injury, and improve the clinical identification and nursing ability of severe hand trauma infection induced by rare pathogenic bacteria. Methods: A 57-year-old female patient who developed Eikenella corrodens infection, suppurative tenosynovitis, suppurative arthritis and osteomyelitis after a toothpick stab injury to the right thumb was enrolled in this study. Comprehensive refined nursing was implemented throughout the treatment, including infection control, pain management, flap blood circulation monitoring, nutritional support, psychological intervention, blood pressure management, rehabilitation training and complication prevention. Multidisciplinary collaborative intervention was carried out in conjunction with the departments of clinical pharmacy, rehabilitation medicine, hyperbaric oxygen and gastroenterology. Results: The patient underwent 7 surgical operations in total. After 54 days of systematic nursing, the infection was effectively controlled, the wound healed completely, and the function of the right thumb recovered gradually. Adverse conditions such as pain, anxiety, hypoalbuminemia and hypokalemia were significantly improved. No complications including vascular crisis, deep vein thrombosis, pulmonary infection and cerebral hemorrhage occurred, and the patient was discharged after recovery. Conclusion: Eikenella corrodens infection is difficult to be cultured, prone to missed diagnosis, and has a protracted disease course. Early definite diagnosis, targeted anti-infective therapy combined with multidisciplinary collaboration and systematic holistic nursing can effectively control the progression of infection, reduce the risk of complications, promote wound healing and limb function recovery, and is of great significance for improving the prognosis of patients.