副肿瘤性天疱疮患者围手术期护理个案研究

Perioperative Nursing Care for Paraneoplastic Pemphigus: A Case Study

摘要: 目的：探讨副肿瘤性天疱疮(PNP)患者围手术期的护理干预要点及临床效果，为该罕见疾病的围手术期护理提供实践依据。方法：回顾性分析1例PNP合并Castleman病复发患者的临床资料，基于个案护理理论与无菌操作、安全护理等核心原则，实施术前皮肤准备、免疫状态评估、心理干预，术中无菌防护、生命体征监测，术后创面精细化管理、并发症防控、营养支持及健康宣教等多维度个体化护理措施。结果：患者围手术期未发生严重感染、皮肤损伤加重、深静脉血栓等并发症，手术切口I期愈合，全身皮肤黏膜糜烂症状逐步缓解，疼痛数字评分法(NRS)评分从术前6分降至术后2分，焦虑自评量表(SAS)评分从术前65分降至出院时40分，术后12天顺利出院；出院后1个月随访，无新水疱生成，生活自理能力完全恢复，健康相关生活质量(QOL)评分较术前提升28%。结论：针对PNP患者皮肤屏障受损、免疫紊乱的病理特点，围手术期实施全流程系统化护理，可有效降低并发症风险，促进患者身心康复，为临床同类病例护理提供参考。

Abstract: Objective: To investigate the key points of perioperative nursing interventions and their clinical outcomes in patients with paraneoplastic pemphigus (PNP), providing practical evidence for the perioperative care of this rare disease. Methods: A retrospective analysis was conducted on the clinical data of a patient with PNP complicated by recurrent Castleman disease. Guided by individualized nursing theory and core principles of aseptic technique and patient safety, a multidimensional care plan was implemented. Interventions included preoperative skin preparation, immune status assessment, and psychological support; intraoperative aseptic precautions and vital signs monitoring; and postoperative meticulous wound care, complication prevention, nutritional support, and health education. Results: No severe perioperative complications occurred, including serious infections, exacerbated skin lesions, or deep vein thrombosis. The surgical incision healed by primary intention, and systemic mucocutaneous erosions gradually resolved. The Numeric Rating Scale (NRS) score for pain decreased from 6 preoperatively to 2 postoperatively, and the Self-Rating Anxiety Scale (SAS) score improved from 65 to 40 at discharge. The patient was successfully discharged on postoperative day 12. At the one-month follow-up, no new blisters had formed, activities of daily living (ADL) were fully restored, and the health-related quality of life (HRQoL) score increased by 28% compared to the preoperative baseline. Conclusion: Given the compromised skin barrier and immune dysregulation characteristic of PNP, implementing a comprehensive, systematic perioperative nursing protocol can effectively reduce complication risks and promote both physical and psychological recovery. This approach provides a valuable reference for the clinical management of similar cases.