贲门失驰缓症患者行经口内镜下食道环形肌切开术的围手术期护理

Perioperative Nursing to Trans-mouth Endoscope Esophagus Annular Muscle Sections for Cardia Achalasia Patients

[目的]总结贲门失驰缓症患者行经口内镜下食道环形肌切开术围手术期的护理经验。[方法]选择2012年1月至2013年2月期间确诊为贲门失弛缓症（AC）并接受经口内镜下食道环形肌切开术（POEM）治疗的20例患者，对其围手术期的护理方法及治疗结果进行回顾性分析。[结果]20例患者均成功施行POEM治疗，其中2例出现食管穿孔，有纵膈和皮下气肿，无临床症状，1周后自行气体吸收；5例在建立隧道时出现黏膜破损。用钛夹夹闭。其余病例未发生并发症，无死亡病例。平均住院天数6.4d，术后3-10d出院。术后第6d、1个月Eckardt评分均较术前明显降低，差异有统计学意义（p＜0.001）即吞咽困难、反流、胸痛症状的程度明显减轻或频率明显降低。[结论]围术期的密切观察与评估、并发症的监控、做好饮食护理，是取得满意疗效的重要保证。

[Objective] To sum up the nursing experience to trans-mouth endoscope esophagus annular muscle sections for cardia achalasia patients. [Method] Choose 20 cases of cardia achalasia（AC） who accepted trans-mouth endoscope esophagus annular muscle section（POEM）, trace back and make analysis on their perioperative nursing and treatment. [Result] 20 cases all took POEM successfully, among which, 2 cases had esophageal perforation, with mediastinum and subcutaneous emphysema, without clinical symptoms, but with gas absorption by itself after lw; 5 cases had injured mucosa in setting tunnel, closed with a titanium clip. Others had no complications, nor death case. The average in-hospital period was 6.4d, they were out of hospital 3-10d after operation. The Eckardt score at 6d and lm after operation reduced markedly compared with before operation, the difference had statistical meaning, i.e. the symptoms degree of dysphagia, reflux and chest pain were obviously relieved or reduced. [Conclusion] The close observation and evaluation in perioperative period, supervision of complications, making good diet nusing are the key guarantee of satisfying curative effect.