内镜下逆行胰胆管造影术后胆道出血的高危因素分析与防护措施

Analysis on risk factors of hemobilia after endoscopic retrograde cholangiopancreatography and its protective measures

目的探讨内镜下逆行胰胆管造影(ERCP)术后胆道出血的高危因素与防护措施。方法选取2016年7月至2019年2月我院收治的110例ERCP患者为研究对象,其中有7例(6.36%)发生术后胆道出血,收集患者年龄、性别、血小板计数、血红蛋白、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原、胆总管结石、壶腹部嵌顿结石等资料,采用多因素logistic回归分析ERCP术后胆道出血的相关因素。结果多因素logistic回归分析显示,急性胆源性胰腺炎、高血压、壶腹部嵌顿结石是影响ERCP术后胆道出血的独立危险因素(P<0.05)。结论护理人员应针对胆道出血的影响因素采取辅助术者术中镜下喷药、电凝、止血夹、血管介入栓塞等措施进行止血,避免和减少ERCP术后胆道出血,提高患者治疗舒适性和安全性。

Objective To investigate the risk factors of hemobilia after endoscopic retrograde cholangiopancreatography(ERCP)and its protective measures.Methods To select 110 cases of patients with ERCP admitted to our hospital from July 2016 to February 2019 as the study subjects.Among them,7 cases(6.36%)developed postoperative hemobilia,and the data such as age,gender,platelet counts,hemoglobin,prothrombin time,activated partial thromboplastin time,thrombin time,fibrinogen,common bile duct stones,and ampulla incarcerated stones,etc.were collected.Multivariate logistic regression analysis was used to anaylze the related factors of hemobilia after ERCP.Results Multivariate logistic regression analysis showed that the acute biliary pancreatitis,hypertension,and ampulla incarcerated stones were the independent risk factors of hemobilia after ERCP(P<0.05).Conclusion Nursing staff should take measures such as intraoperative mirror spraying,electrocoagulation,hemostatic clips,and vascular interventional embolization to help patients with hemobilia to prevent and reduce hemobilia after ERCP,and improve patient comfort and security.