妊娠晚期孕产妇合并急性胆管炎行内镜逆行胰胆管造影术的围术期护理

Perioperative Nursing of ERCP for Pregnant Women with Acute Cholangitis during the Third Trimester of Pregnancy

目的总结妊娠晚期孕产妇合并急性胆管炎行内镜逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography,ERCP)救治的护理经验。方法回顾性分析杭州市第一人民医院消化内科2010年1月至2012年3月收治的妊娠晚期合并急性胆管炎行ERCP救治的17例患者的临床资料,总结其护理经验。结果本研究共纳入17例患者,平均年龄(27.1±4.2)岁,均符合急性胆管炎诊断及ERCP救治指征。7例首次ERCP留置鼻胆引流管者1周内行剖宫产终止妊娠,并在产后1周行二次ERCP术取尽结石;10例ERCP置入胆管内塑料支架者,终止妊娠后1个月内二次ERCP术取出支架并作总管取石或清扫。17例患者临床症状均明显缓解,11例足月产,6例早产,无死胎,产后随访3个月无婴儿夭亡。结论及时采取ERCP救治妊娠晚期孕产妇合并急性胆管炎安全有效;做好围术期配合和心理护理是治疗成功的关键。

Objective To summarize the perioperative nursing strategies of endoscopic retrograde cholangio pancreatography （ERCP） for pregnant women with acute cholangitis during the third trimester of pregnancy. Methods Clinical data of 17 pregnant women with acute cholangitis performed ERCP between January 2000 through March 2012 （n=17） were analyzed and nursing strategies were summarized. Results Seventeen patients were included into the study. Mean age was 27.14-4.2 years. Diagnosis of acute cholangitis and indications for ERCP were clear. All cases received two stages interventions： 7 cases had caesarean birth in one week with Endoscopic Nasobiliary Drainage （ENBD） after the first ERCP,and cleaned their bile ducts by second ERCP 1 week after postpartum. 10 cases received endoscopic retrograde biliary drain- age （ERBD） by bile duct plastic stents,and took out stents and stones by second ERCP between 2 weeks and 1 month after termination of pregnancy. All clinical symptoms were significantly alleviated. A total of 11 cases with full-term birth and 6 cases with premature delivery,no stillbirth were detected. All 18 babies were health in the 3 months＇ follow-up after postpartum. Conclusion ERCP appears to be a safe technique for acute cholangitis during the third trimester of pregnancy. Skillful cooperation and mental nursing aroundthe technical innovation of ERCP are the keys to successful treatment.