| 赵蓓.鼻咽癌患者放疗期间合并中枢性尿崩症1例护理[J].上海护理,2020,20(5):62-64 |
| 鼻咽癌患者放疗期间合并中枢性尿崩症1例护理 |
| 鼻咽癌患者放疗期间合并中枢性尿崩症1例护理 |
| DOI： |
| 中文关键词: 鼻咽癌 中枢性尿崩 放疗 护理 |
| 英文关键词:Nasopharyngeal carcinoma Central diabetes insipidus Radiation therapy Nursing |
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| 中文摘要: |
| 总结1例鼻咽癌放疗患者合并中枢性尿崩症的护理经验。病例：患者因“鼻咽癌放疗后2年余，回缩性血涕半年余”主诉收入院，病理会诊提示鼻咽非角化性癌，未分化型；鼻咽MRI提示鼻咽癌治疗后改变，蝶窦、枕骨斜坡、左侧颞骨岩尖信号异常伴强化，考虑鼻咽癌治疗后，复发可能。放疗期间出现重度电解质紊乱、休克先兆转入ICU抢救，生命体征平稳转回放疗科病房后出现尿崩症状，尿量增多，总尿量达10150ml，每小时尿量最多达1500ml，通过对患者实施尿崩症的护理（水电解质平衡紊乱及出入量的护理、用药护理、体重监测护理、压疮预防护理）、鼻咽癌放疗护理（放疗区皮肤护理、放射性口腔黏膜炎护理）、深静脉通路（CVC）护理、常规跌倒预防护理、心理护理、饮食护理、出院指导等一系列护理措施，最终患者明显好转出院。
结论：存在颅脑侵袭可能的鼻咽癌放疗患者应留意尿量突然增加的情况，警惕中枢性尿崩的发生，及时给予对症救治及护理。 |
| 英文摘要: |
| To summarize the nursing experience of 1 case of during radiotherapy nasopharyngeal carcinoma combined with central diabetes insipidus.CASE: A 45-year-old man was admitted to our hospital for nasopharyngeal carcinoma (NPC) after radiotherapy with more than 2 years, retracted nasal bleeding for more than 6 months. Pathology showed nonkeratinizing and undifferentiated carcinoma. MRI scan of the NP and neck revealed presentation of post-radiotherapy changes and abnormal enhancement to the sphenoid sinus, the occipital slope and the left side of the temporal bone rock peak indicating the relapse of nasopharyngeal carcinoma (NPC) at the skull case. During his hospitalization and treatment, severe electrolyte imbalance and early signs of shock were observed and the patient was transmitted to the ICU for rescue. He returned to radiotherapy department ward after vital signs stabilized, but symptoms of urine collapse appeared soon, urine volume increased with a maximal total amount of daily urine up to 10150 ml and the urine output per hour up to 1500 ml. Through to the nursing care of the diabetes insipidus (nursing of water and electrolyte balance disorder, intake and output record, medication, body weight monitoring, prevention of pressure ulcers), nursing care of radiation-induced adverse events for nasopharyngeal carcinoma (skin care with radiation fields, radiation-induced oral mucositis), nursing care of Central Venous Catheterization (CVC), nursing conventional tumbling prevention, psychological care, dietary nursing care and the patients were significantly improved, then he safe discharged in the end.
CONCLUSION:
Our experience of this case suggests that radiation therapy for intracranial extension should be considered at the time when diabetes insipidus becomes clinically overt. |
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