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

Ulceronnipplecausedbymoxibustionscald:acasereport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。MoxibustionisoneofChina'soldestmedicalskill,belongtophysicaltherapy,litmoxastickwhichmadewithartemisiaeargyi,smokedhumanbodypoints,anaturaltherapyforhealthcare.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。Becauseofthesimplyoperation,peopleoftentakemoxibustionbythemselvesathome,skinburninjuriesareusuallycausedbyimproperuseofmoxibustion,andthewoundisdeep,dressingisdifficulttohealthewoundorneedalongertime.Theburnwoundcausedbymoxibustionusuallyoccurontheleg,thenipplepointisextremelyrareandrelativelyforbidden.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。HuiX,female,53yearsold,complained"chroniculceronleftnippleaftermoxibustionfor1year".Oneyearago,thepatientsufferedburnaccidentallywhiletakingmoxibustionpointonnippleathome,thewoundwasnosignificantlyimprovementafterdressingforalongtimeinthelocalhospitals,forfurthertreatment,shewasadmittedinourdepartment.Previoushistory:breasthyperplasia.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。Specialexamination:ulcerwoundwaslocatedonthemiddleoftheleftnipple,aconcaveshape,someeffusionofapaleyellowliquidwithoutbloody,nipplewasswelling,gotpainsensitivity.Therewasnosignificantodorinthewoundsurface,andtheenlargedlymphnodeswerenotpalpableintheleftarm.Anxietystate:femalemenopause,treatmentlastforalongtime.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。Therewasnoobviousabnormalityinbloodexamination.BreastultrasoundandX-ray:bilateralbreasthyperplasia;multiplecysticnodules.Bacterialcultureofwound:asepticgrowth.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；

RelateddepartmentconsultationDepartmentofgeneralsurgeryconsultation:excludingbreastcancerPsychologicalconsultation:relaxingofthestateofanxiety

三、治疗过程换药(ChangeDressing)：药物:百克瑞(Compoundlysostaphin)、创洁夫(Ag+cleanlinessgermdetergent)、碱性成纤维细胞生长因子(Bisicfibroblastgrowthfactor)、银锌抑菌霜（Zincsilverantibacterialcream

）、粒细胞巨噬细胞刺激因子凝胶(Granulocytemacrophagestimulatingfactorgel）、夫西地酸乳膏（Fusidicacidcream）敷料:德湿银(Silver-containingimpregnateddressing)、创必复(Biologicproteinsponge)、吸水敷料(Therasorbalgiplusadhesivedressing)、伤安素（Carbonfiberdressing

）

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；Negativepressuredrainage:nippleismoresensitivetopain,after5daysoftreatment,nosignificantimprovement,refusedtonegativepressure.Withnosignificantimprovementaftertreatmentofmorethan2months,becauseofthespecialpoint,refusedsurgery;三、治疗过程高渗浓氯化钠湿敷：炎症有所减轻。Hypertonicsodiumchloride:inflammationhasbeenreduced.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。DepartmentoftraditionalChinesemedicineconsultationDialecticaldignosis:Qi-deficiencycausingbloodstasis(apathogenesisintraditionalChinesemedicine(TCM