Nursing care of a case of Wagner grade 4 diabetes foot with necrotizing fasciitis
1例Wagner4级糖尿病足合并坏死性筋膜炎患者的护理

摘要

本文总结1例Wagner 4级糖尿病足合并坏死性筋膜炎患者的护理经验。因患者存在创面愈合障碍、疼痛管理困难、血糖波动等多重护理问题。通过实施感染性休克急救护理、阶段性创面处理（清创期蚕食清创、引流期负压封闭引流、修复期银离子敷料联合生长因子应用）、疼痛与血糖协同管理、血管重建与功能康复训练、营养支持及心理干预等系统化措施，经过护理，患者感染得到控制，创面显著缩小，踝肱指数提升，血糖及营养指标改善，焦虑情绪缓解，可借助助行器行走。本案例表明，针对此类复杂病例，采用多学科协作的阶段性护理策略，能有效促进创面愈合、降低并发症风险，为临床同类病例的护理提供参考。

Abstract

This paper summarized the nursing experience of a case of Wagner grade 4 diabetes foot with necrotizing fasciitis. Due to multiple nursing issues such as wound healing disorders, difficulty in pain management, and blood glucose fluctuations in patients. By implementing systematic measures such as emergency care for septic shock, staged wound management (debridement during debridement, negative pressure closure drainage during drainage, silver ion dressing combined with growth factor application during repair), pain and blood glucose co management, vascular reconstruction and functional rehabilitation training, nutritional support, and psychological intervention, the patient's infection was controlled, the wound significantly reduced, ankle brachial index increased, blood glucose and nutritional indicators improved, anxiety was relieved, and walking aids were used. This case demonstrates that adopting a multidisciplinary collaborative phased nursing strategy for such complex cases can effectively promote wound healing, reduce the risk of complications, and provide reference for the nursing of similar clinical cases.