急诊B超辅助下经皮肝穿刺食管胃底曲张静脉栓塞治疗及护理

Treatment and Nursing of Ultrasonic Guided Percutaneous Transh Epatic Embolization for Esophageal and Gastric Varices

目的探讨急诊B超辅助下经皮肝穿刺食管胃底曲张静脉栓塞治疗的应用价值和临床疗效及护理方法。资料与方法回顾性分析11例急诊行B超辅助定位下经皮肝穿曲张静脉栓塞(percutaneous transhepatic varicesembolization,PTVE)治疗患者的临床资料及护理。结果 11例均积极术前准备,在B超辅助定位引导下一次穿刺成功,栓塞治疗后,均经造影确认曲张静脉消失。术后严密观察病情,及时预防及处理并发症,加强疼痛、饮食护理。所有患者均出血停止,血压回升至>90/60 mmHg(1 mmHg=0.133kPa)。11例均无严重并发症发生。介入手术前后肝、肾及凝血功能对照显示,手术后白蛋白较手术前有升高,经t检验显示差异有统计学意义(P<0.05);其余肝、肾功能指标及凝血酶原时间手术后较手术前有改善,但经配对资料t检验显示差异无统计学意义(P>0.05)。结论食管静脉曲张上消化道出血患者,急诊B超辅助定位下行PTVE,提高了穿刺成功率,缩短了操作时间。为控制出血、抢救生命争取了时间。经观察并发症少,对肝、肾功能无不良影响,通过加强护理进一步巩固了PTVE的疗效,临床疗效较好,值得进一步研究应用。

Objective To investigate the clinical value and care methods of emergent ultrasonic assisted percutaneous transhepatic embolization（PTVE）.Materials and Methods The clinical and nursing data of 11 cases of esophageal and gastric varices who underwent emergent ultrasonic assisted percutaneous embolization were analyazed retrospectively.Serum albumin,liver function,renal function and prothrombin time were tested before and after embolization.Results All the cases had successful puncture guided by ultrasound.The esophageal and gastric varices were disappeared on radiography and bleeding stopped after embolization.Patients were under intensive care after operation in order to prevent and deal with complications.No severe complication occurred.Blood pressure rose to 90/60 mmHg and above.Serum albumin level significantly rose（P0.05）.liver function,renal function and prothrombion time were improved（P0.05）.Conclusion Ultrosound guided PTVE can be used for patients with upper gastrointestinal bleeding due to esophagus and gastric varices.This technique shorten operation time to control bleeding,and make it possible to save life.With the technique fewer complication occurred,no side effect to liver function and renal function.What＇s more,intensive care can consolidate the treatment efficiency of PTVE.