恶性梗阻性黄疸合并大量腹水患者行PTCD术后双重固定引流管的效果观察

The Effect of Dual Fixed Application in the Patients with Malignant Obstructive Jaundice combined with Ascites after PTCD

目的:探讨造口袋联合引流管固定器双重固定方式在恶性梗阻性黄疸合并大量腹水患者行经皮肝穿刺胆道内引流术(percutaneous transhepatic cholangiography drainage,PTCD)术后的临床应用效果。方法:选取56例行PTCD术的恶性梗阻性黄疸合并大量腹水的患者,随机分为两组,每组28例。试验组采用造口袋联合引流管固定器双重固定PTCD管;对照组采用无菌纱布交叉覆盖PTCD管周并用胶布粘贴。观察比较两组患者的PTCD管周皮肤情况、PTCD管固定、引流及患者PTCD留置期间的舒适度(活动得分、疼痛及睡眠评分)等情况。结果:试验组PTCD管周皮肤刺激性皮炎的发生率和部分脱管及完全脱管的发生率低于对照组,试验组PTCD留置舒适度高于对照组,差异均有统计学意义(P<0.05)。试验组PTCD引流打折/受压发生率高于对照组,但差异无统计学意义(P>0.05)。结论:造口袋联合引流管固定器双重固定方式能够降低PTCD管周皮肤刺激性皮炎的发生率,加强恶性梗阻性黄疸合并大量腹水患者PTCD管的固定,不影响PTCD的引流,提高了患者PTCD留置期间的舒适度,值得推广应用。

Objective： To explore the effect of colostomy bag combined with drainage tube fixator after percutaneous transhepatic cholangiography drainage（ PTCD） in patients with malignant obstructive jaundice combined with ascites.Methods： Fifty-six patients with malignant obstructive jaundice combined with ascites who accepted the treatment of PTCD were selected and divided into two groups randomly. In experimental group,dual fixed method with colostomy bag and drainage tube fixator was applied to fix the tube of PTCD. In control group,adhesive tape was used to fix the tube. The skin status around the PTCD tube,the fixation and drainage effect,as well as the comfort level of patients were compared.Results： The incidence of irritant dermatitis around PTCD drainage tube in the experimental group were lower than that in the control group,and the fixation effect and comfort level of patients of experimental group were higher than those of the control group（ P〈0. 05）. No statistical difference was observed of the effect of drainage between these two groups（ P〉0. 05）. Conclusion： Dual fixed application with colostomy bag plus drainage tube fixator in patients with malignant obstructive jaundice combined with ascites is helpful for reducing the incidence of irritant dermatitis around the PTCD tube,as well as improve the fixation effect of PTCD tube and enhance the comfort degree of patients.