Application of psychological intervention in intensive care unit nursing for patients with severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a familiar critical disease in the intensive care unit(ICU)patients.Nursing staff are important spiritual pillars during the treatment of patients,and in addition to routine nursing,more attention needs be paid to the patient’s psychological changes.AIM To investigate the effects of psychological intervention in ICU patients with SAP.METHODS One hundred ICU patients with SAP were hospitalized in the authors’hospital between 2020 and 2023 were selected,and divided into observation and control groups per the hospitalization order.The control and observation groups received routine nursing and psychological interventions,respectively.Two groups are being compared,using the Self-rating Anxiety Scale(SAS),Self-Determination Scale(SDS),Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ,and 36-item Short Form Health Survey(SF-36)scores;nursing satisfaction of patients;ICU care duration;length of stay;hospitalization expenses;and the incidence of complications.RESULTS After nursing,the SDS,SAS,and APACHEⅡ scores in the experimental group were significantly lower than in the control group(P<0.05).The SF-36 scores in the observation group were significantly higher than those in the control group(P<0.05).The nursing satisfaction of patients in the experimental group was 94.5%,considerably higher than that of 75.6% in the control group(P<0.05).The ICU care duration,length of stay,and hospitalization expenses in the observation group were significantly lower than those in the control group,and the incidence of complications was lower(P<0.05).CONCLUSION For patients with SAP,the implementation of standardized psychological intervention measures can effectively alleviate adverse psychological conditions.

A Study on the Application of Evidence-Based Nursing in The Care of Patients with Severe Acute Pancreatitis

Objective: To explore the application research of evidence-based nursing in the care of patients with severe acute pancreatitis. Methods: This study focuses on evidence-based nursing care of severe acute pancreatitis. Patients with severe acute pancreatitis who received treatment in our hospital were selected, from which 80 cases were chosen for detailed analysis. The patients were randomly grouped into a control group (conventional nursing care) and a study group (evidence-based nursing care), with 40 patients each. Relevant research data were recorded during the nursing process, analyzed, and used as research indicators. Results: The hospitalization time and morbidity and mortality rate of the research group were shorter than those of the control group, and the recovery rate was higher than that of the control group (P < 0.05). Patient satisfaction with nursing care in the observation group was higher than in the control group (P < 0.05). Conclusion: For patients with severe acute pancreatitis, the use of evidence-based nursing methods effectively reduced the patient’s mortality rate, improved its curative effect, and also shortened the patient’s hospitalization time.

The Effect and Nursing of Indwelling Nasal Jejunal Feeding Tube for Enteral Nutrition in Acute Severe Pancreatitis

Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.

Effect of acupoint application combined with microwave treatment on the intestine barrier functional disturbance of moderately severe acute pancreatitis

Objective: To explore and analyze the effect of acupoint application combined with microwave treatment on the intestinal barrier dysfunction with moderately severe acute pancreatitis. Methods: A convenient sample of 90 moderately severe acute pancreatitis was selected from March 2017 to December 2017 in the comprehensive hospital with third grade in Tianjin. The patients were divided into group A (acupoint application combined with microwave treatment), group B (acupoint application) and group C (routine nursing). Thirty patients were included in each group. This study need to get the informed consent of the patients. Acupoint application combined with microwave treatment was used, basing on routine nursing measures in group A. Acupoint application was used by the same way and the same traditional Chinese medicine ,basing on routine nursing measures in group B. Routine nursing used in group C. C-reactive protein and the score of intestinal function were measured on 3 th day, 7 th day and 10 th day, after intervention. To record the effective ratio of the treatment after 10 days of intervention. Results: There are significant statistical difference among the three group after intervention (P < 0.05). Conclusion: In some way, acupoint application combined with microwave treatment are able to decrease the time about the recovery of intestinal barrier dysfunction in moderately severe acute pancreatitis and to alleviate the suffering of patients.

Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution:A prospective randomized double-blind study

AIM: To compare the benefi cial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP).METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE Ⅱ score, Balthazar’s CT score and CRP were assessed daily during the study period.RESULTS: The median duration of hospital stay was shorter in the study group [10 ± 4 (8-14) d vs 15 ± 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 ± 2 (5-8) d vs 6 ± 2 (5-7) d]. The median duration of EN was 8 ± 4 (6-12) d vs 10 ± 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE Ⅱ normalization (APACHE Ⅱ score < 8) was shorter in the study group than in the control group (4 ± 2 d vs 6.5 ± 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 ± 2 d vs 10 ± 3 d, P < 0.05).CONCLUSION: Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy.

How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification

AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery,Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE Ⅱ scale. Clinical course was re-evaluated after 24,48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild,moderately severe,and severe.Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol(42.7%) followed by alimentary(26.2%),biliary(26.2%) and idiopathic(4.9%). Under Atlanta 1992 classification 56(54.4%) cases were classified as "mild" and 47(45.6%) as "severe". Using the revised classification(Atlanta 2012),the patient stratification was different: 49(47.6%) mild,27(26.2%) moderately severe and 27(26.2%) severe AP cases. The two severe groups(Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters,including ICU stay,need for interventional treatment,infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients(according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP(according to Atlanta 1992) with lower incidence of necrosis and sepsis,lower APACHE Ⅱ(P = 0.002) and MODS(P = 0.001) scores,shorter ICU stay,decreased need for interventional and surgical treatment.CONCLUSION Study shows that Atlanta 2012 criteria are more accurate,reduce unnecessary treatments for patients with mild and moderate severe pancreatitis,potentially resulting in health costs savings.

Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome

Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.

Study progress in therapeutic effects of traditional Chinese medicine monomer in severe acute pancreatitis

Severe acute pancreatitis (SAP) is a common acute abdomen clinical problem characterized by high mortality, mul-tiple complications, complicated pathogenesis and difficult treatment. Recent studies found traditional Chinese medicine (TCM) monomers have markedly good effect for treating SAP. Many TCM monomers can inhibit pancreatin, resist inflammation, im-prove microcirculation and immunoloregulation, etc. to block the pathological progress of SAP in multiple ways, reduce com-plications and lower mortality with rapid effects. It is significant for enhancing SAP treatment to deeply understand the current situation in TCM monomers for treating SAP and take precious references therein. This article summarizes the treating effects and mechanisms of TCM monomers for SAP in recent years.

Analysis of the risk factors for severity in post endoscopic retrograde cholangiopancreatography pancreatitis: The indication of prophylactic treatments

To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis (sPEP) and clarify the indication of prophylactic treatments. METHODSAt our hospital, endoscopic retrograde cholangiopancreatography (ERCP) was performed on 1507 patients from May 2012 to December 2015. Of these patients, we enrolled all 121 patients that were diagnosed with post endoscopic retrograde PEP. Fourteen of 121 patients diagnosed as sPEP were analyzed. RESULTSForty-one patients had contrast media remaining in the pancreatic duct after completion of ERCP. Seventy-one patients had abdominal pain within three hours after ERCP. These were significant differences for sPEP (P < 0.05). The median of Body mass index, the median time for ERCP, the median serum amylase level of the next day, past histories including drinking and smoking, past history of pancreatitis, sphincter of Oddi dysfunction, whether emergency or not, expertise of ERCP procedure, diverticulum nearby Vater papilla, whether there was sphincterotomy or papillary balloon dilation, pancreatic duct cannulation, use of intra-ductal ultrasonography enforcement, and transpapillary biopsies had no significant differences with sPEP. CONCLUSIONContrast media remaining in the pancreatic duct and the appearance of abdominal pain within three hours after ERCP were risk factors of sPEP.

Treatment of severe acute pancreatitis through retroperitoneal laparoscopic drainage

A treatment method based on drainage via retroperitoneal laparoscopy was adopted for 15 severe acute pancreatitis(SAP)patients to investigate the feasibility of the method.Ten patients received only drainage via retroperitoneal laparoscopy,four patients received drainage via both retroperitoneal and preperitoneal laparoscopy,and one patient received drainage via conversion to laparotomy.Thirteen patients exhibited a good drainage effect and were successfully cured without any other surgical treatment.Two patients had encapsulated effusions or pancreatic pseudocysts after surgery,but were successfully cured after lavage and B ultrasound-guided percutaneous catheter drainage.SAP treatment via retroperitoneal laparoscopic drainage is an effective surgical method,resulting in minor injury.

Review:Advances in researches on the immune dysregulation and therapy of severe acute pancreatitis

During the development and progression of severe acute pancreatitis(SAP) ,conspicuous immune dysregulation develops,which is mainly manifested as excessive immune response in the early stage and immunosuppression in the late stage. This process involves complex changes in a variety of immune molecules and cells,such as cytokines,complements,lymphocytes,and leukocytes. With the gradual deepening of studies on the development and progression of SAP,the role of immune dysregulation in the pathogenesis of SAP has attracted more and more attention. In this article,we review the advances in research on the immune dysregulation in SAP and the immunotherapy of this disease through exploring the formation of excessive immune response and immune suppression as well as their mutual transformation.

重症急性胰腺炎患者急救护理流程再造及应用效果

目的:探讨重症急性胰腺炎(severe acute pancreatitis,SAP)患者急救护理流程再造及应用效果。方法:选取2019年1月—2022年1月样本医院收治的94例SAP患者作为研究对象,将2019年1月—2020年6月样本医院收治的47例SAP患者设为对照组,将2020年7月—2021年12月应用基于流程再造理论重组院内SAP急救护理流程的47例SAP患者设为研究组,比较两组患者急救效率和救治结局。结果:研究组分诊时间、候诊时间和就诊时间均短于对照组,差异有统计学意义(t=12.743、9.136、7.075,P<0.05)。研究组再入院率低于对照组,差异有统计学意义(χ^(2)=4.424,P<0.05)。死亡率比较差异无统计学意义(χ^(2)=0.261,P>0.05)。研究组满意度评分高于对照组,差异有统计学意义(t=6.231,P<0.001)。结论:对SAP患者应用基于流程再造理论重组急救护理流程,可提高SAP急救效果,改善患者救治结局。

循证护理模式对重症急性胰腺炎患者生活质量和自护能力的影响

目的探讨循证护理模式对重症急性胰腺炎患者生活质量、自我护理能力、预后的影响。方法选取2021年7月至2022年7月右江民族医学院附属医院收治的90例重症急性胰腺炎患者作为研究对象,按照随机数字表法分为参照组(45例)与干预组(45例),参照组采用常规治疗和护理,干预组在常规接受常规治疗和护理基础上,采用循证护理模式。比较两组生活质量、自我护理能力及并发症发生情况。结果护理前,两组患者生活质量、自我护理能力评分比较,差异无统计学意义(P>0.05);护理后,干预组生活质量评分、自我护理能力评分高于参照组,差异有统计学意义(P<0.05),并发症发生率及C反应蛋白、血清淀粉酶、血糖水平低于参照组,血清钙水平高于参照组,差异有统计学意义(P<0.05)。结论循证护理模式应用于重症急性胰腺炎患者中,有效提高患者生活质量及自我护理能力,减少并发症发生,改善疾病预后。

芒硝、小茴香腹壁外敷辅助治疗急性重症胰腺炎的标准化护理

目的:探讨标准化护理在芒硝腹壁外敷辅助治疗急性重症胰腺炎中的应用效果。方法:选取兰州大学第二医院2020年1月—2022年12月采取芒硝、小茴香交替腹壁外敷辅助治疗的急性重症胰腺炎患者100例,随机分为对照组(常规护理)与观察组(标准化护理),每组50人,对比干预效果。结果:观察组腹痛消失时间、腹胀消失时间、肠鸣音恢复时间更短(P<0.05)。观察组护理满意度更高(P<0.05)。结论:对采取芒硝、小茴香交替腹壁外敷辅助治疗的急性重症胰腺炎患者实施标准化护理,能够及早减轻患者临床症状,提高其生活质量,且对护患关系的改善有利,值得采纳、推广。

重症急性胰腺炎评分量表及诊疗进展

重症急性胰腺炎死亡率高、病情变化快且常伴有一种甚至多种并发症。此文通过对各种胰腺炎评分量表的适用范围及优缺点的学习有助于临床医师评估病情及判断预后,同时文章对于重症急性胰腺炎的诊断、治疗进行了综述,以期为临床医生对于重症急性胰腺炎的诊疗提供参考。

一例重症急性胰腺炎并发重型Stevens-Johnson综合征/中毒性表皮坏死松解症患者的感染防控

目的 总结1例重症急性胰腺炎(SAP)患者治疗期间并发重型Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)的感染防控经验和体会。方法 我院于2021年3月12日收治1例SJS/TEN患者。护理要点:包含从疾病本身出发识别感染源、采取有针对性措施控制感染源、集束化方案切断传播途径、提高自身免疫力以保护感染人群4方面。其中重点针对患者皮肤损伤在同一时段的不同表现,采取分阶段的皮肤护理策略;充分补液,准确控制出入量,早期进行营养支持;及时予心理护理及适时的镇痛措施,缓解焦虑情绪。结果 患者于入院后103 d痊愈顺利出院。结论 股骨近端防旋髓内钉内固定手术中应用仰卧“剪刀”体位并结合护理人员针对性的术前情绪管理、深呼吸训练、咳嗽训练、卧床排便,术中体位摆放,术后功能锻炼可缩短患者手术时间,减少术中出血量及术中透视次数,降低并发症发生率,值得临床推广。

重症急性胰腺炎行肠内营养病人动态腹内压监测预警分级标准及干预方案的构建

目的:构建重症急性胰腺炎(SAP)行肠内营养病人动态腹内压监测预警分级标准及干预方案。方法:检索国内外文献,拟定SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案初稿。采用德尔菲专家函询法对专家进行2轮函询,形成SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案。结果:2轮专家函询的问卷回收率均为100%,专家权威系数均为0.918,变异系数分别为0.077~0.156和0.056~0.167,肯德尔协调系数分别为0.353和0.331(P<0.001)。最终形成包含3项一级指标、13项二级指标、26项三级指标的SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案。结论:本研究构建的SAP行肠内营养病人动态腹内压监测预警分级标准及干预方案具有一定的科学性和实用性,有利于指导临床实践。

乌司他丁联合生长抑素治疗重症急性胰腺炎的临床疗效分析

目的探究乌司他丁联合生长抑素治疗重症急性胰腺炎的临床疗效。方法便利选取山东省济南市章丘区中医医院于2019年6月-2023年9月收治的78例重症急性胰腺炎患者为研究对象,采用密闭信封法分为对照组和研究组,各39例。所有患者均采用常规治疗,对照组在此基础上使用生长抑素,研究组在对照组基础上静脉注射乌司他丁。对比两组临床疗效及不良反应发生率,检测肿瘤坏死因子-α、白细胞介素-6、C反应蛋白、淀粉酶、谷丙转氨酶、肌酐水平,并对比生活质量简表(World Health Organization Quality of Life-100,WHOQOL-100)评分。结果研究组治疗总有效率为97.44%,高于对照组,差异有统计学意义(χ^(2)=3.924,P=0.048)。治疗后,研究组各项血清指标水平低于对照组,差异有统计学意义(P<0.001)。两组不良反应发生率对比,差异无统计学意义(P>0.05)。治疗后,研究组WHOQOL-100评分高于对照组,差异有统计学意义(P<0.05)。结论重症急性胰腺炎患者应用乌司他丁联合生长抑素治疗效果显著,可提高治疗有效率,改善血清指标水平,用药安全性较高,从而提高患者生活质量。

重症急性胰腺炎诱发胃黏膜剥脱大出血1例

急性胰腺炎(acutepancreatitis,AP)病情进展快、个体差异大、隐匿性强,常伴有胰腺脓肿、休克、多脏器功能衰竭等严重并发症,但AP所致的胃黏膜剥脱伴大出血在临床较罕见。本文回顾性分析1例因重症AP诱发胃黏膜剥脱并消化道出血的临床病例,探讨该病例的诊断、治疗及预后等,以期加强对重症AP罕见并发症的临床认识,并为其临床诊治提供参考。

通腑解毒汤联合常规西医治疗重症急性胰腺炎的效果

目的:探讨通腑解毒汤联合常规西医治疗重症急性胰腺炎(SAP)的临床效果。方法:选取2021年1月—2023年12月毕节市中医医院收治的65例SAP患者作为研究对象,按随机数表法分为对照组(n=33)及观察组(n=32)。对照组行常规西医治疗,观察组加用通腑解毒汤治疗,持续10 d。比较两组临床疗效、症状消失时间、血流动力学指标、炎症水平、急性生理与慢性健康状况(APACHEⅡ)评分、Marshall多脏器功能障碍(MODS)评分。结果:观察组总有效率高于对照组,差异有统计学意义(P<0.05)。观察组发热消失时间、腹痛消失时间、呕吐消失时间、血清淀粉酶复常时间及首次排便时间短于对照组,差异有统计学意义(P<0.05)。治疗后,观察组心率(HR)、血乳酸(BL)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)低于对照组,平均动脉压(MAP)高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组APACHEⅡ评分、MODS评分低于对照组,差异有统计学意义(P<0.05)。结论:通腑解毒汤联合常规西医治疗SAP患者效果显著,可加快体内炎症消退,纠正心率、血压异常,促进疾病症状消失。