全程超声引导下经皮门静脉穿刺胰岛移植术的护理

Nursing assistance during whole-process ultrasound-guided percutaneous portal vein puncture for islet transplantation

目的 总结糖尿病患者实施全程超声引导下经皮门静脉穿刺胰岛移植术的护理要点,为该类患者提供护理经验。方法 本院于2017年12月至2023年9月对27例(44例次)患者进行了全程超声引导下经皮门静脉穿刺置管胰岛移植术,并配合做好术前、术中、术后护理工作。结果 27例(44例次)患者均顺利完成手术。其中3例次(6.8%)术中出现上腹部及肝区疼痛、恶心呕吐,8例次(18.2%)术中出现门静脉压力一过性升高,6例次(13.6%)拔除门静脉插管后发生活动性出血;术后所有患者均无迟发性门静脉活动性出血、门静脉血栓形成等并发症。结论 术前访视患者了解病情,做好心理护理和相关疾病知识宣教工作;术中密切监测患者生命体征、门静脉压力及血糖,预防并发症发生;术后预防门静脉活动性出血,对确保超声引导下经皮门静脉穿刺胰岛移植术顺利完成具有重要作用。

Objective To compile nursing guidelines for diabetic patients undergoing ultrasound-guided islet transplantation through percutaneous portal vein puncture and catheterisation,providing valuable insights for the care of such patients during the surgical procedure. Methods Between December 2017 to September 2023,a total of 27 patients underwent 44 surgical procedures for ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterisation at our hospital. Nursing assistance was provided preoperatively,intraoperatively and postoperatively for all the procedures. Results All 27 patients who had undergone 44 surgical procedures successfully went through the ultrasound-guided islet transplantation via percutaneous portal vein puncture and catheterisation. Among the 44 surgical procedures,3 (6.8%) resulted in upper abdominal and liver area pain,nausea and vomiting during surgery,8 (18.2%) had transient increase of portal vein pressure during transplantation,and 6 (13.6%) encountered active bleeding following the removal of the portal vein catheters. None of the patients developed delayed portal vein bleeding or complication such as portal vein thrombosis after the surgery. Conclusions Nursing interventions play a crucial role in ensuring the successful outcomes of ultrasound-guided islet transplantation. Following measures are the keys and they play an important roles in ensuring the smooth completion of ultrasound-guided islet transplantation:preoperatively,carefully assess the condition of recipients and provide them with psychological supports and patient education. Intraoperatively,closely monitor the vital signs,portal vein pressure and blood glucose as well as to prevent complications. Postoperatively,implement the nursing measures to prevent the recipients from postoperative bleeding of portal vein.