阶梯式引流新模式在重症急性胰腺炎坏死感染患者护理中的应用

Application of stepped drainage new model in nursing care for severe acute pancreatitis patients with necrosis and infection

目的总结阶梯式引流新模式在重症急性胰腺炎坏死感染患者中应用的护理关键内容。方法2014年1月—2016年12月解放军东部战区总医院普通外科重症监护室共收治重症急性胰腺炎(SAP)合并胰腺坏死感染(IPN)患者417例。治疗过程中采用"四步法"阶梯式引流模式,即:经皮穿刺置管引流、持续负压冲洗引流、内镜引流、剖腹坏死组织清除引流术4个阶段。护理上各阶段存在共同点,但侧重点不同,分别注重加强腹腔穿刺导管的护理、腹腔双套管的护理、内镜操作配合的护理、开腹手术后护理等。结果417例SAP合并IPN患者中经皮穿刺置管引流413例,单患者穿刺1~7根引流管,共计2 252根;腹腔双套管冲洗引流315例,单患者放置双套管2~7根,共计1 386根;内镜引流186例,单患者内镜清除坏死组织2~5次,共计725次;开腹手术91例次,单患者开腹1~3次。护理期间,经皮穿刺引流管及腹腔双套管滑脱共计13次,双套管引流期间发生双套管引流不佳109例次,其中引流管阻塞56例次,打折30例次,出血7例次,移位16例次。均被及时发现并及时处理,无一例因引流不佳护理不当而造成不良后果。结论掌握每个阶段SAP合并IPN患者护理重点,对患者实施针对性护理措施,保持腹腔穿刺引流管通畅,腹腔双套管有效吸引,配合内镜坏死组织清除,加强术后监测及创面管理等,是保证SAP合并IPN患者得到优质护理的关键。

Objective To summarize the key content of nursing of stepped drainage new model for severe acute pancreatitis(SAP)patients with necrosis and infection.MethodsFrom January 2014 to December 2016,we selected 417 SAP patients with infected pancreatic necrosis(IPN)in General Surgery Intensive Care Unit at Nanjing General Hospital,People's Liberation Army.The"four-step"stepped drainage model was adopted during treatment including four stages,percutaneous catheter drainage,continuous negative pressure irrigation drainage,endoscopic drainage and laparotomy necrotic tissue debridement drainage.All stages of nursing had something in common and different emphasis points.Nursing care paid attention to strengthening the nursing for abdominal puncture catheter,abdominal double pipe,endoscopic operation cooperation and postoperative nursing of laparotomy.ResultsAmong 417 SAP patients with IPN,a total of 413 patients were with percutaneous catheter drainage and single patient was with one to seven drainage tubes,a total of 2 252 tubes;315 patients were with abdominal double pipe irrigation drainage and single patient was with two to seven double pipes,a total of 1 386 double pipes;186 patients were with endoscopic drainage and single patient was with two to five times of endoscopic necrotic tissue debridement,a total of 725 times;91 patients were with laparotomy and single patient was with laparotomy one to three times.During nursing care,totals of 13 percutaneous drainage catheters and abdominal double pipes slipped off;109 cases of poor drainage happened to double pipe drainage with 56 cases of obstructed drainage;there were 30 cases of folding,7 cases of hemorrhage and 16 cases of shifting.Those problems were all found and handled timely with no consequence caused by poor drainage and improper nursing care.ConclusionsAmong SAP patients with IPN,keys to guarantee high quality of nursing included mastering nursing emphasis of all stages,taking targeted nursing,keeping abdominal puncture catheter unobstructed,abdominal double pipes effectively sucking,cooperating on endoscopic necrotic tissue debridement and strengthening postoperative monitoring and wound management.