Lange M P, Thebo L M, Tiede S M, McCarthy B, Dahn M S, Jacobs L A
Department of Nursing, Veterans Administration Medical Center, Allen Park, MI 48101.
Heart Lung. 1989 Jul;18(4):386-90.
Enterocutaneous fistulas present a difficult management problem in the intensive care unit. Although some patients require surgical intervention for fistula control, key elements to good clinical management include mechanical control and vigorous nutritional support. This approach includes eradication of malnutrition, support of the hypercatabolic state, and maintenance or replacement of protein loss from fistula drainage. Good mechanical control involves integument protection and a mechanism of drainage collection. The patient we describe taxed the ingenuity and creativity of all those concerned with his care. Modification of a previously described technique to protect surrounding skin and collect fistula output served as a simple and inexpensive approach to eliminate infection potential, improve the patient's comfort, and decrease the nursing time that would have been required for frequent, complex dressing changes.
肠外瘘在重症监护病房中是一个难以处理的管理问题。尽管一些患者需要手术干预来控制瘘管，但良好临床管理的关键要素包括机械控制和积极的营养支持。这种方法包括消除营养不良、支持高分解代谢状态以及维持或补充因瘘管引流导致的蛋白质损失。良好的机械控制包括皮肤保护和引流收集机制。我们所描述的这名患者考验了所有参与其护理人员的智慧和创造力。对先前描述的一种技术进行改良，以保护周围皮肤并收集瘘管排出物，这是一种简单且经济的方法，可消除感染风险、提高患者舒适度，并减少频繁进行复杂换药所需的护理时间。
