经十二指肠镜胆管记忆合金支架置入术配合及护理.docVIP

经十二指肠镜胆管记忆合金支架置入术配合及护理[摘要] 目的：探讨内镜下胆管记忆合金支架临床应用中的护理方法。方法：回顾26例ERCP胆管记忆合金支架置入术前、术后护理及术中配合。结果：26例病人记忆合金支架置入后症状明显缓解，能及时观察常见并发症，经治疗护理后均顺利出院。结论：术前良好心理指导、术中准确配合、术后精心护理是手术成功的重要因素。 [关键词] ERCP；记忆合金支架；术中配合；护理 [中图分类号] R473.5[文献标识码]C [文章编号]1673-7210（2008）09（b）-129-02 To explore the nursing cooperation points of patients underwent memory alloy stand in the surgery of ERCP CAI Xia, LI Qing-he,JIANG Dan-bin (Endoscopy center, Affiliated Yancheng Hospital, Medical college of Southeast University,Yancheng224001,China) [Abstract] Objective：To investigate the nursing Methods and the nursing cooperation points of patients underwent memory alloy stand in the surgery of ERCP. Methods：To retrospectively analyse the nursing measures on 26 patients underwent memory alloy stand in the surgery of ERCP who received the Pre-and post-operative nursing as well as perioperative coordination nursing during May,2004 to December,2007. Results：The clinical symptoms alleriated obviously in all of the 26 patients, and the operative complications were observed promptly. All patients recovered successfully and discharged after operation in 4～6 d. Conclusion：The results show that the adequate pre-operation preparation, preoperative mental guidance, precise intraoperative cooperation and meticulous nursing care are important factors to ensure operation success. [Key words] ERCP；Memory alloy stent；Intraoperative Coordination；Ｎursing 恶性梗阻性黄疸多由胆管癌、胰腺癌、十二指肠乳头癌、壶腹部癌、胆囊癌、肝癌及其他转移癌对胆管压迫所致，此类患者应首选手术治疗。由于就诊时往往已出现严重梗阻性黄疽，临床治疗较为棘手，手术切除率仅为10.4%，手术病死率为13%。我院从2004年5月～2007年12月对26例恶性梗阻性黄疸开展十二指肠镜胆管记忆合金支架置入引流术（EMBE），现将护理措施介绍如下： 1临床资料 1.1一般资料 本组26例，其中男12例、女14例，年龄57～70岁，平均64.3岁，以黄疸、腹痛、发热为主要症状入院。经B超、CT或核磁共振胆管成像(MRCP)等确诊肝癌6例，胆总管下段癌10例，胰头癌4例，乳头癌6例。 1.2方法 26例患者均先行ERCP检查，确定病变部位，测量狭窄长度及狭窄程度，严重者行探条扩张，所用支架为南京微创公司生产的镍钛记忆合金支架，支架长度一般为X+(1~2) cm（X为病变狭窄长度），支架释放过程，必须在X线监视下，与医生密切配合，不断调整支架位置，使支架在最佳位置释放。26例患者记忆合金胆道支架均一次释放成功。支架释放后，胆道低位梗阻者可见胆汁流出，高位梗阻者可见梗阻部位以上胆管内造影剂下泄。 1.3疗效的观察与判断 将术后1～2周血清胆红素下降程度1/2术前胆