【摘要】：目的考察經(jīng)皮肝穿刺膽管引流術(PTCD)聯(lián)合膽道金屬支架植入術治療惡性梗阻性黃疸患者的護理療效,歸納并探究治療前后并發(fā)癥的護理體會。方法回顧性分析肝膽外科2008年4月—2014年3月行PTCD聯(lián)合膽道支架植入術的34例惡性梗阻性黃疸患者的護理。結果 34例經(jīng)皮肝穿刺膽管引流術(PTCD)聯(lián)合膽道金屬支架植入術全部成功,黃疸5 d內退凈6例,黃疸2周內退凈18例,2周內黃疸明顯減輕7例。皮膚、鞏膜黃染及皮膚瘙癢癥狀3~7 d消失,大小便顏色2~5 d恢復正常;血尿淀粉酶明顯升高5例,經(jīng)4~7 d應用生長抑素后治愈;局限性膽汁性腹膜炎4例,重新放置PTCD引流管后癥狀消失;引流管脫出2例,經(jīng)及時處理后好轉出院;夾管帶管出院1例。所有患者均未出現(xiàn)穿孔、腹膜炎等其他嚴重并發(fā)癥。結論 PTCD結合膽道金屬支架置入治療惡性梗阻性黃疸患者效果良好、創(chuàng)傷小;合理、有效、優(yōu)質的圍手術期護理可促進手術成功及為良好預后提供重要保證。系統(tǒng)的個性化的護理方案以及切實有效的措施可為支架植入患者的恢復提供重要保障。同時,在臨床護理過程中仍然需要不斷探索及總結經(jīng)驗,使患者能更好地配合治療并增加戰(zhàn)勝疾病的信心,積極的心理狀態(tài)可以促進患者康復。
[Abstract]:Objective to investigate the nursing effect of percutaneous transhepatic bile duct drainage (PTCD) combined with biliary metal stent implantation in patients with malignant obstructive jaundice, and to summarize and explore the nursing experience of complications before and after treatment. Methods the nursing care of 34 patients with malignant obstructive jaundice underwent PTCD combined with biliary stent implantation in hepatobiliary surgery from April 2008 to March 2014 was retrospectively analyzed. Results all 34 cases of percutaneous transhepatic bile duct drainage (PTCD) combined with biliary metal stent implantation were successful. Jaundice in 6 cases within 5 days, jaundice in 18 cases within 2 weeks, and jaundice in 7 cases within 2 weeks. The symptoms of skin, scleral yellow stain and pruritus disappeared in 3 and 7 days, and the color of urine returned to normal for 5 days, and the serum amylase increased significantly in 5 cases, which was cured by somatostatin for 4 days. In 4 cases of localized biliary peritonitis, the symptoms disappeared after re-placement of PTCD drainage tube, 2 cases with prolapse of drainage tube, and 1 case with clip tube and tube were discharged from hospital after timely treatment. No perforation, peritonitis and other serious complications were found in all patients. Conclusion PTCD combined with metallic biliary stent implantation in the treatment of malignant obstructive jaundice is effective, less traumatic, reasonable, effective and high quality perioperative nursing can promote the success of operation and provide important guarantee for good prognosis. Systematic individualized nursing program and effective measures can provide important protection for patients with stent implantation. At the same time, in the process of clinical nursing, we still need to explore and sum up the experience, so that the patients can cooperate better with the treatment and increase the confidence to overcome the disease. Positive psychological state can promote the recovery of the patients.
【作者單位】： 蚌埠醫(yī)學院第一附屬醫(yī)院肝膽外科;
【基金】：安徽省科技攻關項目(1501041155)
【分類號】：R473.73

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