早期微创腹腔置管灌洗治疗重症急性胰腺炎的观察及护理

目的观察早期微创腹腔置管灌洗治疗重症急性胰腺炎(SAP)效果及总结护理要点。方法采用微创的方法,在床边对16例SAP患者采用腹腔置管灌洗,同时给予生长抑素、抑酸、抗感染、营养支持等综合治疗,在腹腔灌洗前及灌洗后24h、48h、72h分别测量患者腹水淀粉酶及APACHEⅡ(急性生理和慢性健康评估系统)评分。结果16例患者经过腹腔灌洗后病情均有不同程度的好转,腹水淀粉酶从灌注前的(1957.6±87.8)U/L降至灌注48h后(201.5±19.8)U/L,72h后(161.6±17.9)U/L;APACHEⅡ分值从灌洗前的(12.6±2.68)分降至灌注48h后(5.0±1.2)分,72h后(4.3±1.1)分。结论早期微创腹腔置管灌洗治疗能有效提高SAP的治愈率。治疗过程,护理人员应加强病情观察和腹腔灌洗的护理,其是保证患者早期微创腹腔置管灌洗治疗SAP顺利进行的有效措施。

Objective To investigate the effect of the peritoneal lavage through placement of central venous catheter in the treatment of severe acute pancreatitis （SAP） and summarize the key points of nursing. Methods Sixteen SAP patients were treated with peritoneal lavage through placement of central venous catheter as well as with comprehensive therapy of use of somatostatin, acid-inhabitation, anti-infection and nutrition supporting. The ascites amylases before and after peritoneal lavage were tested at hours 24, 48 and 72 and APACHE II was used to make assessments. Results 24 hours after lavage all patients＇ general condition were improved at different degrees： The ascites amylase dropped significantly from （1 957.6 ± 87.8）U/L before the treatment to （201.5± 19.8）U/L 48 hours after the treatment, and to （161.6 ± 17.9）U/L in 72 hours. The APACHE Ⅱ scores were also decreased dramatically from （12.6 ± 2.68） before the treatment to （4.95 ± 1.18） 48 hours after the treatment, and to （4.3 ± 1.1）in 72 hours. Conclusion The placement of central venous catheter in the treatment of SAP may improve efficacy to a great extent. Strengthening disease observation and nursing for peritoneal lavage can be effective for the successful peritoneal lavage through placement of central venous catheter in SAP.