艾灸烫伤乳头致难愈性溃疡一例的治疗与思考

艾灸烫伤乳头致难愈性溃疡一例的治疗与思考 Ulcer on nipple caused by moxibustion scald :a case report,解放军总医院第一附属医院创口修复中心 汇报人 张海军 郝岱峰 冯 光 褚万立 李 涛 张媛媛李善友 赵景峰 张新建 陈泽群 赵 帆,一、背景资料(Background),二、病例资料(Case),三、治疗过程(Treatment),四、体会思考(Discussion),一、背景资料(Background),艾灸是中国最古老的医术之一，属于物理疗法，点燃用艾叶制成的艾炷、艾条为主，熏烤人体的穴位以达到保健治病的一种自然疗法。Moxibustion is one of Chinas oldest medical skill, belong to physical therapy, lit moxa stick which made with artemisiae argyi , smoked human body points, a natural therapy for health care.,一、背景资料,因操作简单，患者往往在家自行艾灸，因使用不当造成皮肤烫伤者屡见不鲜，且伤后创面较深，换药难以愈合或需时间较长。因艾灸穴位常容易发生在小腿部位，乳头部位烫伤极为少见，且在艾灸中属相对禁忌部位。Because of the simply operation, people often take moxibustion by themselves at home, skin burn injuries are usually caused by improper use of moxibustion, and the wound is deep, dressing is difficult to heal the wound or need a longer time. The burn wound caused by moxibustion usually occur on the leg , the nipple point is extremely rare and relatively forbidden.,一、背景资料(Background),二、病例资料(Case),三、治疗过程(Treatment),四、体会思考(Discussion),二、病例资料,惠X，女，53岁，主诉“左侧乳头艾灸后慢性溃疡1年”。患者1年前在家中自行艾灸乳中穴时不慎烫伤乳头，在当地医院换药未见明显好转，为求进一步治疗，于我科门诊收治入院。既往有乳腺增生病史，无糖尿病等其它疾病病史。Hui X,female, 53 years old, complained chronic ulcer on left nipple after moxibustion for 1 year. One year ago, the patient suffered burn accidentally while taking moxibustion point on nipple at home , the wound was no significantly improvement after dressing for a long time in the local hospitals, for further treatment, she was admitted in our department. Previous history : breast hyperplasia.,二、病例资料,入院专科查体：左侧乳头正中可见溃疡创面，局部呈凹陷状，可见少量渗出液，为淡黄色无血性液体，乳头红肿明显，疼痛敏感。创面无明显异味，左腋下未触及肿大淋巴结。伴明显焦虑状态：女性更年期，治疗周期长。Special examination: ulcer wound was located on the middle of the left nipple, a concave shape, some effusion of a pale yellow liquid without bloody, nipple was swelling,got pain sensitivity. There was no significant odor in the wound surface, and the enlarged lymph nodes were not palpable in the left arm.Anxiety state: female menopause, treatment last for a long time .,二、病例资料,血液检查未见明显异常。乳腺超声及钼靶:双侧乳腺增生；多发囊性结节。创面细菌培养：无菌生长。,There was no obvious abnormality in blood examination.Breast ultrasound and X-ray: bilateral breast hyperplasia; multiple cystic nodules.Bacterial culture of wound: aseptic growth.,一、背景资料(Background),二、病例资料(Case),三、治疗过程(Treatment),四、体会思考(Discussion),三、治疗过程,相关科室会诊普外科会诊：排除乳腺癌；心理科会诊：解除焦虑状态；,Related department consultationDepartment of general surgery consultation: excluding breast cancerPsychological consultation: relaxing of the state of anxiety,三、治疗过程,换药(Change Dressing)：药物:百克瑞(Compound lysostaphin)、创洁夫(Ag+ cleanliness germ detergent)、碱性成纤维细胞生长因子(Bisic fibroblast growth factor)、银锌抑菌霜（Zinc silver antibacterial cream ）、粒细胞巨噬细胞刺激因子凝胶(Granulocyte macrophage stimulating factor gel）、夫西地酸乳膏（Fusidic acid cream）敷料:德湿银(Silver-containing impregnated dressing)、创必复(Biologic protein sponge)、吸水敷料(Therasorb algiplus adhesive dressing)、伤安素（Carbon fiber dressing ）,三、治疗过程,负压封闭引流：乳头较为敏感，经5天治疗后无明显改善，拒绝再行负压。经2月余治疗后无明显好转，建议患者手术切除，因部位特殊，拒绝手术；Negative pressure drainage: nipple is more sensitive to pain, after 5 days of treatment, no significant improvement, refused to negative pressure. With no significant improvement after treatment of more than 2 months ,because of the special point, refused surgery;,三、治疗过程,高渗浓氯化钠湿敷：炎症有所减轻。Hypertonic sodium chloride: inflammation has been reduced.,三、治疗过程,中医科会诊辩证：气虚血瘀（由于气虚，推动、温煦血液作用减弱，导致血液循环迟缓不畅，甚至凝滞不行的病理状态）建议采用中药复方调理。Department of traditional Chinese medicine consultationDialectical dignosis: Qi-deficiency causing blood stasis(a pathogenesis in traditional Chinese medicine(TCM).It is a morbid state of slow flow and even stasis of the blood resulting from Qi deficiency which makes the fuction of propelling and warming blood disturbed.)Recommended :Apply drugs of TCM.,三、治疗过程,创面逐渐好转，溃疡面缩小，最终愈合The wound gradually improved, the ulcer surface reduced, and finally healed.,三、治疗过程,出院一年后随访：溃疡无复发，外观良好。 One year follow-up after discharge: no recurrence of ulcer, good appearance.,一、背景资料(Background),二、病例资料(Case),三、治疗过程(Treatment),四、体会思考(Discussion),四、体会思考,避免自行艾灸需专业医师指导，正规医疗机构，避免烫伤事件发生。Avoid self-moxibustionRequire professional medical guidanceRegular medical institutionsAvoid the occurrence of burns.,四、体会思考,坚持创面处理 尽管多种药物及敷料应用效果欠佳，但其在减轻炎症反应、抑制创面溃疡加深扩大等方面起到一定的作用。Wound treatmentAlthough application many kinds of drugs and dressing effect is not very good, but it plays a certain role in reducing the inflammatory reaction, inhibiting the expansion of wound ulcers and so on.,四、体会思考,辅助治疗调节心理状态 更年期女性，治疗周期长，情绪波动较大；中医辨证调理，西药控制症状，努力配合治疗。Regulating mental state by complementary treatmentMenopausal women, the treatment is long time, emotional fluctuationsDiagnosis and treatment based on an overall analysis of the illness and the patients condition, and drugs control the symptoms, make efforts