Nursing care of patients with malignant obstructive jaundice treated by biliary stent implantation via ERCP
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摘要: 目的 总结内镜逆行胰胆管造影(ERCP)下胆道支架置入治疗恶性梗阻性黄疸的术后护理体会并观察临床疗效。 方法 选取2010年1月-2016年9月期间蚌埠医学院第一附属医院和温州医科大学附属第二医院收治并行经ERCP途径胆道支架置入的101例恶性梗阻性黄疸患者,总结术后护理情况,分析术后1周及1个月患者血清中总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)、谷丙转氨酶(ALT)、谷草转氨酶(AST)及白蛋白(ALB)的变化情况。随访至2017年9月或患者死亡,记录患者的生存时间,绘制生存曲线。 结果 所有患者均成功置入胆道支架,术后皮肤瘙痒等症状有不同程度的改善;与术前相比,患者术后1周及1个月血清中TBIL、DBIL、ALP、ALT、AST水平均明显下降,差异具有统计学意义(均P<0.001);与术前相比,患者术后1周及1个月血清中ALB水平明显升高,差异具有统计学意义(P<0.001)。并发症发生率为42.6%(43/101),给予对症处理及精心护理后均治愈。术后平均生存时间为(8.96±1.02)个月,中位生存时间为9个月。 结论 经ERCP途径胆道支架置入治疗恶性梗阻性黄疸疗效确切,且术后严密的观察和精心的护理措施至关重要。
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关键词:
- 恶性梗阻性黄疸 /
- 内镜下逆行胰胆管造影 /
- 胆道支架 /
- 护理
Abstract: Objective To evaluate the clinical efficacy and to summarize the nursing experience of biliary stent placement via ERCP approach in the treatment of malignant obstructive jaundice. Methods The postoperative nursing experience of 101 patients with malignant obstructive jaundice treated with biliary stent placement via ERCP from January, 2010 to September, 2016 was summarized. In addition, we observed the changes of serum total bilirubin(TBIL), direct bilirubin (DBIL), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) after the operation.Patients were followed up until September, 2017 or death. The survival time was recorded and the survival curve was drawn. Results In the study, all patients had a success operation. The symptoms such as itching were significantly improved after the operation. Compared with the preoperative levels, the levels of TBIL, DBIL, ALP, ALT, and AST significantly decreased 1 week and 1 month after the operation, and the differences were statistically significant (P<0.001). In addition, the level of albumin (ALB) significantly increased 1 week and 1 month after the operation, with statistical significance (P<0.001). The overall complication rate was 42.6% (43/101) and all of them cured after the symptomatic treatment and meticulous care. The average survival time was (8.96±1.02) months, and the median survival time was 9 months. Conclusion ERCP-based biliary stents are effective in the treatment of malignant obstructive jaundice. However, strict observation and careful nursing after operation are very important.
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