内镜下治疗十二指肠乳头括约肌切缘出血的护理配合技巧

Nursing Cooperation Skill in Endoscopic Treatment of Pro-Endoscopic Sphincterotomy Hemorrhage

目的探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术后十二指肠乳头括约肌切缘出血内镜下止血治疗的操作护理配合与技巧。方法纳入2011年3月至2020年2月在我院内镜中心行ERCP治疗后出现十二指肠乳头括约肌切缘或周围出血并行内镜下止血治疗的患者77例,根据出血位置及出血量选用合适的止血方法,通过术中精准的医护配合及熟练的护理操作配合技巧,分析内镜下止血治疗的成功率及安全性。结果所有患者均行内镜下止血治疗,其中76例成功止血,1例经内镜止血治疗后仍有活动性出血表现,经数字减影血管造影技术(digital silhouette angiography,DSA)成功止血。内镜下止血总体成功率为98.7%(76/77)。内镜下止血治疗后有5例发生轻度并发症,无严重并发症,其中3例轻度胆管炎、2例轻症胰腺炎,并发症发生率为6.5%,均经静脉用药后成功治愈,无晚期相关并发症的发生。结论ERCP术后出现十二指肠乳头切缘或周围出血经内镜下止血治疗是安全可行的,操作护士术中熟练的操作技巧、默契的医护配合,是此项治疗成功率和安全性的重要保证。

Objective To explore the nursing cooperation and skills of endoscopic treatment of hemorrhage after endoscopic retrograde cholangiopancreatography(ERCP).Methods Totally 77 patients who were suffered from pro-sphincterotomy hemorrhage after ERCP and treated with concurrent endoscopic hemostasis therapy in the endoscopy department from March 2011 to February 2021 were included in this study.Appropriate hemostasis method was selected according to the location and amount of bleeding.Through intraoperative precise medical cooperation and skilled nursing operation cooperation skills,the success rate and safety of endoscopic hemostasis treatment were analyzed.Results Endoscopic hemostasis was performed in all patients with duodenal papillary margin or peripheral bleeding after ERCP.Among them,76 cases were successfully hemostatic,1 case still had active bleeding after endoscopic hemostatic treatment,and was successfully hemostatic by digital silhouette angiography(DSA).The overall success rate of endoscopic hemostatic rate was 98.7%(76/77).After endoscopic hemostasis,5 cases had mild complications,including 3 cases of mild cholangitis and 2 cases of mild pancreatitis.The complication rate was 6.5%.They were successfully cured after intravenous medication,and there were no late related complications.Conclusions Endoscopic treatment of pro-endoscopic sphincterotomy hemorrhage is safe and feasible,and expected to become one of the preferred methods of the treatment.The skilled operation technique and tacit medical cooperation of operating nurses can significantly improve the success rate and safety of treatment.