,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,大疱性类天疱疮,患者的护理,主讲人：刘 静,时 间：201,6,年1月,12,日,大疱性类天疱疮患者的护理www.themegallery.,主要内容,护 理 措 施,4,概 述,1,临 床 表 现,2,专科会诊意见,3,总 结,5,主要内容护 理 措 施 4概 述,一、概 述,1.,定义：,大疱性类天疱疮（,Bullous pemphigoid,，,BP,）,:,是最常见的表皮下自身免疫性大疱病，它以皮肤或粘膜处紧张性的大疱或糜烂为特征。,2.,流行病学：,天疱疮和类天疱疮是两种最常见的器官特异性自身没免疫性大疱病，具有慢性、复发性和严重性等特点，如不及时治疗可危及生命。天疱疮的年发病率为（,0.5-3.2,）,/10,万，类天疱疮的年发病率为,1/10,万。,一、概 述 1.定义：2.流行病学：,二、临床表现,1.,红斑水肿型类天疱疮,2.,脂溢性类天疱疮,4.,结节性类天疱疮,3.,增殖性类天疱疮,常,见,分,型,（一）临床分型,二、临床表现 1.红斑水肿型类天疱疮 2.脂溢性类天疱疮4.,1.,损害对称发生，水疱常见于颈部、腋窝、腹股沟、大腿内侧和上腹部；,2.,水疱可随病情发展出现血疱、糜烂、结痂，水疱成群发生时，类似疱疹样皮炎。大小自樱桃大到核桃大，直径最大可达,7cm,。,二、临床表现,（二）典型症状和体征,1.损害对称发生，水疱常见于颈部、腋窝、腹股沟、大腿内侧,二、临床表现,（二）典型症状与体征,3.,水疱破溃后如无继发感染，常很快结痂。糜烂面愈合较快。痂脱落后常有色素沉着，偶见萎缩瘢痕，有时合并粟丘疹。,4.,黏膜损害发生于约,20%,30%,的患者，为界限清楚的糜烂，主要为口腔黏膜，咽、喉及生殖器部位黏膜损害罕见。,5.,尼氏征常阴性。,二、临床表现（二）典型症状与体征 3.水疱破溃后如无继发感,尼氏征（,Nikolsky,）：,又称棘层细胞松解现象检查法，是皮肤科常用的体格检查方法之一，具体表现如下：,(1),牵扯患者破损的水疱壁，尼氏征阳性者可将角质层剥离相当长的一段距离，甚至包括看来是正常的皮肤。,(2),推压两个水疱中间的外观正常的皮肤时，尼氏征阳性者角质层很容易被擦掉，而露出糜烂面。,(3),推压患者从未发生过皮疹的完全健康的皮肤时，尼氏征阳性者很多部位的角质层也可被剥离。,(4),以手指加压在水疱上，尼氏征阳性者可见到水疱内容物随表皮隆起而向周围扩散。,(5),在口腔内，用舌添及粘膜，可使外观正常的粘膜表层脱落或撕去。,二、临床表现,尼氏征（Nikolsky）：又称棘层细胞松解现象,三、专科会诊意见,（一）,皮肤科,1.,护士在为患者做护理时戴手套，但避免橡胶手套；测血压时用纱布包裹；留置针要避开皮肤损伤部位，用多功能带固定，少用胶布；按时给患者翻身，翻身时用无菌垫，尽量让病人自己动；男性患者，用丁字带托起阴囊；,2.,使用无菌床上用品，严重者使用无菌纱垫,6-8,层；用无菌垫垫起患者足跟；,3.,加强营养，,以温热饮食为主，,鼓励病人多下床活动；,三、专科会诊意见 （一）皮肤科,（二）烧伤科,1.,大面积损伤患者家属也需穿隔离衣，戴无菌手套；,2.,用烤灯照射，特别是腋窝等部位，保持干燥；,3.,一次性护理垫不要直接接触患者皮肤；,4.3%,的硼酸湿敷、干燥、收敛。,三、专科会诊意见,4.,注意预防继发感染：清洁病人的手及手指甲，必要时带手套；禁止患者及家属用手乱摸伤口；伤口要暴露，炉甘石抹在没有皮肤损害的地方；,5.,外用止痛药