内镜逆行胰胆管造影术围手术期的护理观察

内镜逆行胰胆管造影术(encoscopic retrograde cholangio pancreatography,ERCP)是一种微创介入性检查和治疗手段,是当前诊断胰胆管疾病的金标准[1]。为提高ERCP术患者围手术期的护理效果,我科对行ERCP术患者实施细致的护理,取得了满意的效果,现报道如下。     

内镜下逆行胰胆管造影围手术期及术后护理

目的：对ERCP围手术期及术后观察、护理进行总结与分析。方法：对67例入住我科,并行诊断性或治疗性ERCP术的患者的临床诊疗经过、围手术期准备及术后观察护理进行回顾性分析总结。结果：61位患者术后未见明显并发症,有较严重并发症患者6例,其中急性胰腺炎3例,术后乳头创面出血2例,并发胆道出血1例,经积极治疗及精心护理后均康复出院。结论：ERCP是诊断、治疗肝、胰、胆管疾病的重要、有效手段,其术前及术后观察、护理对手术的成败起重要作用。     

经内镜逆行胰胆管造影567例围手术期护理体会

目的提高经内镜逆行胰胆管造影(ERCP)的护理水平,减轻患者痛苦,同时降低术后并发症。方法回顾2010年1月至2010年12月于我院消化医学中心共就诊的567例ERCP检查及治疗患者,对术前、术中、术后的注意事项及观察护理进行总结。结果术前了解患者的一般情况,消除患者的心理顾虑;术中熟练地配合医生;术后进行休息和饮食指导,观察患者生命体征及腹痛等并发症情况,在护理工作的密切配合下ERCP的成功率达99%。结论 ERCP是诊治胆胰疾病的微创方法,掌握适应证及禁忌证,做好术前、术中、术后护理工作对操作成功非常重要。     

内镜下逆行性胰胆管造影患者的护理

对91例胆管疾病患者施行逆行胰胆管造影（ERCP）加十二指肠乳头切开取石,对患者术前、术中及术后护理工作进行总结。术前向患者做好解释工作,术中配合医生协助患者翻身,严格无菌操作,术后进行饮食指导,观察患者生命体征及病情变化,做好心理护理,可减轻患者痛苦及术后并发症。     

老年患者经内镜逆行性胰胆管造影术围手术期的护理体会

目的：总结老年患者经内镜逆行性胰胆管造影术（ERCP）围手术期的护理体会。方法以38例行ERCP的老年患者为研究对象,患者均行ERCP治疗。患者ERCP围手术期护理干预措施如下：术前完善术前基础准备、心理护理,术中体位护理、插管护理、体征监测,术后饮食护理、病情观察、术后并发症的预防及护理。结果38例患者均成功进行ERCP。术后2例患者发生急性胰腺炎并发症,1例患者发生出血并发症,1例患者发生胆道感染并发症,予以相应的护理及治疗后均恢复良好,痊愈出院。结论老年患者ERCP围手术期予以精心的护理配合干预是提高ERCP成功率、促进患者痊愈出院的关键环节。     

逆行胰胆管造影的护理体会

逆行胰胆管造影(ERCP)是一种诊断胰腺及胆道疾病的常用方法,它不仅对胰腺及胆道疾病具有重要诊断价值,在此基础上还广泛应用于胰、胆疾病的治疗.我科一年来对30例此类患者进行了ERCP,在医护积极协作下,取得了满意效果,现就护理体会介绍如下.     

经内镜逆行胰胆管造影的术前及术后护理

目的：提高经十二指肠逆行胰胆管造影的成功率，减少患者痛苦，预防并发症；方法：对我科2008～2009年60例适应症患者的术前，术后护理进行总结；结果：介入手术过程顺利，及时发现并发症，并给予精心的治疗与护理均痊愈。结论：通过开展此项技术加之精心护理，使患者满意度提高。     

内镜逆行胰胆管造影术的护理

随着消化内镜技术的不断发展，内镜逆行胰胆管造影术(ERCP)已成为目前国内胰胆疾病可靠的诊断手段和微创性治疗方法。我科2000年10月～2002年6月共行ERCP检查192例，并利用ERCP和EST(内镜括约肌切开术)诊断和治疗胆总管继发结石取得满意疗效。现将护理体会介绍如下：     

内镜逆行胰胆管造影的并发症及其护理

内镜逆行胰胆管造影（ERCP）是在十二指肠镜直视下，将造影管经十二指肠乳头开口插入胰管和胆管，从而直接观察十二指肠乳头形态及X线影像，观测胰腺、胆囊、胆管、肝管有无病变。将其作为诊断胰胆系统疾病的金标准在临床已应用多年，诊断价值已得列公认。     

咪达唑仑联合丙泊酚麻醉在老年患者内镜下逆行胰胆管造影术中的应用

目的:观察咪达唑仑联合丙泊酚麻醉在老年患者内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)中的效果和安全性。方法:52例急诊行ERCP检查和治疗的老年患者,采用咪达唑仑联合丙泊酚麻醉,按10-8-6方案输注丙泊酚,先以负荷量咪达唑仑0.02 mg/kg及丙泊酚1 mg/kg,静脉输注时间20 s,诱导剂量后以10 mg·kg-1·h-1的速率静脉输注丙泊酚,10 min后减为8 mg·kg-1·h-1,20 min后减为6 mg·kg-1·h-1直至术毕,以维持丙泊酚血浆靶浓度约为3μg/ml。记录给药前、给药后1 min、内镜插入食管、停药、苏醒期5个时点的收缩压、舒张压、心率、血氧饱和度和各阶段时程以及术中不良反应情况,术后调查遗忘率和满意度。结果:给药后各时点收缩压与给药前差异均无统计学意义(P0.05)。给药后1 min至清醒时舒张压均下降(P0.05～P0.01)。术中心率和血氧饱和度均无明显变化(P0.05)。患者均有顺行性遗忘,总遗忘率为100.00%,总满意度达98.08%。结论:咪达唑仑联合丙泊酚麻醉适用于老年患者急诊ERCP,是一种较为安全有效的方法。     

环泊酚在无痛内镜逆行胰胆管造影术中的应用效果研究

目的探究不同剂量环泊酚复合舒芬太尼在无痛内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)中的应用效果。 方法选取因胆总管结石拟行无痛ERCP的患者150例,采用随机数字表法将患者随机分为3组,分别为C组50例、R1组50例、R2组50例。C组采用0.1 μg舒芬太尼联合2 mg/kg丙泊酚诱导,6 mg/(kg·h)丙泊酚术中维持方案;R1组采用0.1 μg/kg舒芬太尼联合0.4 mg/kg环泊酚诱导,1 mg/(kg·h)环泊酚术中维持方案;R2组采用0.1 μg/kg舒芬太尼联合0.5 mg/kg环泊酚诱导,1.5 mg/(kg·h)环泊酚术中维持方案。比较3组镇静成功率、不良事件发生率、血流动力学等指标。结果3组患者麻醉诱导后即刻MOAA/S评分、诱导完成30 s后MOAA/S评分、呛咳发生率、苏醒时间差异无统计学意义（P>0.05）;与C组比较,R1组、R2组体动发生率与镇静成功率差异无统计学意义（P>0.05）;与R1组比较,R2组的体动发生率更低,镇静成功率更高。3组患者心动过缓、呃逆、术后恶心的发生率差异无统计学意义（P>0.05）;与C组比较,R1组低血压发生率更低（P<0.05）,R1组、R2组呼吸抑制发生例数更少（P<0.05）,R1组、R2组注射痛更少（P<0.05）。3组患者各时间段心率变化无统计学意义（P>0.05）;3组患者进入检查室时、转入苏醒室时平均动脉压差异无统计学意义（P>0.05）;与C组相比,麻醉诱导后R1组、R2组平均动脉压更高（P<0.05）,十二指肠乳头插管后R1组平均动脉压更高（P<0.05）,手术结束时R1组平均动脉压更高（P<0.05）;与R1组相比,R2组十二指肠乳头插管后平均动脉压较低（P<0.05）。 结论以0.1 μg/kg舒芬太尼联合0.5 mg/kg环泊酚诱导及1.5 mg/(kg·h)环泊酚术中维持方案在无痛ERCP中应用效果较好,兼具了镇静成功率高及不良事件发生率低的优点。     

Application of endoscopic retrograde cholangiopancreatography in biliary-pancreatic diseases

Background Endoscopic retrograde cholangiopancreatography （ERCP） has been used increasingly for the treatment of choledocholithiasis, gallstone pancreatitis, and benign or malignant bile duct or pancreatic duct stenosis. The purpose of this study was to evaluate ERCP for the diagnosis and therapy of biliary-pancreatic diseases. Methods A total of 2075 patients who underwent diagnostic and therapeutic ERCP from June 2001 to March 2009 were analyzed retrospectively. Achievement and complication rates were calculated, and the therapeutic effect was observed. Results In all the 64 cases who underwent diagnostic ERCP, the procedure was successful, in 2011 cases therapeutic ERCP was performed, and the success rate was 94.6%. In the therapeutic ERCP cases, 1434 （93.0%） were successful among the 1542 cases of choledocholithiasis, and 422 （90.0%） of the 469 cases with benign or malignant bile duct or pancreatic duct stenosis, or acute obstructive suppurative cholangitis with stent placement or endoscopic nasobiliary drainage were successful. Fifty-nine （90.8%） cases of the 65 who underwent a pre-cut for pancreatic sphincterotomy were successful. Complication rate was 5.1% and the most frequent complication was acute pancreatitis （4.4%）. Conclusions ERCP is one of the major diagnostic and therapeutic methods for biliary-pancreatic disease. Therapeutic ERCP is a minimally invasive, safe and effective treatment method for various biliary-pancreatic diseases.     

50例梗阻性黄疸患者内窥镜逆行胰胆管造影分析

目的 探讨内窥镜逆行胰胆管造影(ERCP)对梗阻性黄疸的临床诊断价值.方法 回顾性分析经手术或病理诊断证实的50例梗阻性黄疸患者的临床资料和ERCP表现.结果 恶性梗阻性黄疸ERCP多表现为胆管梗阻端呈偏心结节状充盈缺损或呈截断状,边缘不光整,管壁僵硬,其上方胆管呈"软藤征"表现;良性梗阻性黄疸ERCP多表现为胆管梗阻端呈杯口状,管壁柔软,其上方胆管扩张呈"软藤征"表现.结论 ERCP对梗阻性黄疸有一定的诊断价值,它能显示梗阻的程度、阻塞的部位及病因,对指导临床治疗及术后评估能提供可靠的依据.     

75例逆行性胰胆管造影术后相关并发症分析

目的探讨经内镜逆行胰胆管造影(ERCP)并发症的防治措施。方法对2008年5月至2011年8月施行的75例ERCP患者的临床资料进行回顾性分析。结果 75例ERCP成功率为89.3%(67/75),出现并发症22例(29.3%),ERCP术后胰腺炎(PEP)6例(8.0%),一过性高淀粉酶血症13例(17.3%),胆道感染3例(4.0%),无胆道出血及胆道穿孔病例。未出现与ERCP术相关的死亡病例。发生并发症的患者经保守治疗好转。结论诊治性ERCP并发症大多经保守治疗能够治愈,且高淀粉酶血症/PEP主要与胰管显影、插管困难、ERCP操作时间过长等有关。     

乌司他丁和加贝酯预防ERCP术后胰腺炎的荟萃分析

Abstract Background and aim: Post endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is regarded as one of the worrisome complications of endoscopic retrograde cholangiopancreatography (ERCP). Results of randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate on PEP are contradictory. The present study is designed to evaluate the preventive effect of ulinastatin and gabexate mesylate on PEP with a meta-analysis of randomized controlled trials. Methods: Five electronic databases were searched for randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate on PEP. Effects were summarized with the methods recommended by the Cochrane Collaboration. Results: Twelve studies including 5105 participants were included in this meta-analysis. Administration of ulinastatin decreased the incidence of PEP, but only at sufficient doses (OR, 0.39; 95%CI, 0.19 to 0.81; P=0.01). Number needed to treat (NNT) was 6. And administration of ulinastatin also reduced the incidence of post ERCP hyperamylasemia (OR, 0.40; 95%CI, 0.28 to 0.58; P<0.00001). Gabexate mesylate was effective in the prevention of PEP when administered at high doses and as slow infusions (OR, 0.44; 95%CI, 0.25 to 0.79; P=0.006) or at low doses and as rapid infusions (OR, 0.37; 95%CI, 0.20 to 0.69; P=0.002). NNT was 7 and 6 respectively. However, administration of gabexate mesylate at low doses and as slow infusions was ineffective (OR, 0.99; 95%CI, 0.64 to 1.55; P=0.98). Administration of gabexate mesylate had the tendency to reduce post ERCP hyperamylasemia rate, but not to a statistical significance (OR, 0.86; 95%CI, 0.73 to 1.01; P=0.06). Conclusion: Ulinastatin and gabexate mesylate are recommended to be used for the prophylaxis of PEP. However, gabexate mesylate should be administered at high doses and as rapid infusions. And the doses of ulinastatin should be sufficient.     

Effect of endoscopic retrograde cholangiopancreatography combined with laparoscopy and choledochoscopy on the treatment of Mirizzi syndrome

Background Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic （Calot＇s） triangle and the difficulty of separating tissue can lead to bile duct injury and other intraoperative and postoperative complications. The aim of this study is to investigate minimally invasive means of treating different types of Mirizzi syndrome. Methods Fifty-four patients diagnosed with Mirizzi syndrome were enrolled between July 2004 and May 2012. The diagnosis was further refined according to the Csendes classification. Twenty-seven patients were treated with a combination of endoscopic retrograde cholangiopancreatography （ERCP）, laparoscopy, and choledochoscopy （tripartite approach group）; type I in 16 cases, type II five cases, and type III in six cases. Twenty-seven patients were treated with laparotomy （routine approach group）; type I in 19 cases, type II in six cases, and type III in two cases. The operation time, blood loss during operation, initiation of intake time of food, postoperative complications, and hospital stays were compared between two groups. Results All patients were successfully cured in surgical operation. The operation time was （49.7±27.5） minutes, blood loss during operation was （21.1±15.9） ml, initiation of intake time of food was （6.3±2.7） hours, postoperative complications were with two cases （7%, 2/27）, and hospital stay was （6.7±1.8） days in the tripartite approach group. In the routine approach group, the operation time was （85.1±20.3） minutes, blood loss during operation was （150.3±20.5） ml, initiation of intake time of food was （36.6±10.3） hours, postoperative complications were with three cases （11%, 3/27）, and hospital stay was （10.9±3.4） days. Except for postoperative complications, there were significant differences in the operation time, blood loss during operation, initiation of intake time of food, and hospital stays between two groups （P 〈0.05）. Conclusions ERCP combined with laparoscopy and choledochoscopy is a safe and effective means of treating Mirizzi syndrome. The approach is minimally invasive and patients recover quickly requiring only brief hospitalization.     

右美托咪啶复合芬太尼清醒镇静用于经内镜逆行胰胆管造影检查临床观察

目的观察右美托咪啶复合芬太尼清醒镇静用于经内镜逆行胰胆管造影(ERCP)检查的安全性及可行性。方法 60例美国麻醉医师协会分级Ⅰ～Ⅱ级拟行ERCP检查的患者分为右美托咪啶组和丙泊酚组,每组30例。2组患者ERCP检查前静脉注射山莨菪碱10.0 mg和芬太尼1.0μg.kg-1,右美托咪啶组患者15 min内静脉注射右美托咪啶0.5μg.kg-1,以右美托咪啶0.5～1.0μg.kg-1.h-1持续微泵输注至手术结束;丙泊酚组患者2 min内静脉注射丙泊酚1.0 mg.kg-1,以丙泊酚4.0～6.0 mg.kg-1.h-1持续微泵输注至手术结束。记录麻醉前(T0)、进镜前(T1)、进镜时(T2)、进镜后20 min(T3)和检查结束后10 min(T4)患者的血压、心率(HR)和脉搏血氧饱和度(SpO2);并对插管的难易程度、患者的合作程度进行评分,次日评估患者对检查的满意程度。结果麻醉前2组患者收缩压(SBP)、舒张压(DBP)、HR和SpO2比较差异均无统计学意义(P>0.05)。右美托咪啶组患者T1、T2、T3和T4时HR均显著低于T0时(P<0.05),各时间点SBP和DBP比较差异均无统计学意义(P>0.05)。丙泊酚组患者T1、T2、T3和T4时SBP、DBP和HR均显著低于T0时(P<0.05)。2组患者各时间点SpO2比较差异均无统计学意义(P>0.05)。丙泊酚组患者T1时SBP和T1、T2、T3、T4时DBP均显著低于右美托咪啶组(P<0.05),但2组T2、T3和T4时SBP比较差异无统计学意义(P>0.05);丙泊酚组T1、T2、T3和T4时患者HR显著高于右美托咪啶组(P<0.05)。右美托咪啶组操作难易程度和患者合作程度评分显著高于丙泊酚组(P<0.05)。2组患者对检查的满意程度比较差异无统计学意义(P>0.05)。结论右美托咪啶复合芬太尼清醒镇静用于ERCP检查安全可行,能满足检查所需镇静要求,并可获得患者较好的合作;但部分患者发生HR减慢,需采取干预措施。     

Application of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of pancreaticobiliary disease

Pancreaticobiliarydiseaseiscommonineasterncountries.Clinicaldiagnosisis"lainlybasedonimagingfindings.Endoscopicretrogradecholangiopancreatography(ERCP)playsanimportantroleindiagnosingthediseases,especiallyinthediagnosisanddifferenciatlonofpancreticobiliarylithiasls,pancreaticobiliarymalignanttumorandchronicpancreaticdisease.SinceendoscopicpapillotomywasintroducedInthemiddleof1970s,physicianshavebeenabletomakeartincisionattheduodenalpapilla,andremovebileductstoneswithendoscope,avoidinglaproto…     

Preventive effect of ulinastatin and gabexate mesylate on post-endoscopic retrograde cholangiopancreatography pancreatitis

Background Post-endoscopic retrograde cholangiopancreatography pancreatitis （PEP） is regarded as one of the worrisome complications of endoscopic retrograde cholangiopancreatography （ERCP）. Results of randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate （GM） on PEP are contradictory. The present study was designed to evaluate the prophylactic effect of ulinastatin and GM on PEP with meta-analyses of randomized controlled trials （RCTs）. Methods Five electronic databases were searched for RCTs evaluating the preventive effect of ulinastatin and GM on PEP. Summary effects were assessed with the methods recommended by the Cochrane Collaboration. Results Twelve studies involving 5105 participants were included in our meta-analyses. Administration of ulinastatin decreased the incidence of PEP only at sufficient doses （OR, 0.39; 95% C/, 0.19 to 0.81; P=0.01）. Number needed to treat （NNT） was 6. And administration of ulinastatin also reduced the incidence of post-ERCP hyperamylasemia （PEHA） （OR, 0.40; 95% C/, 0.28 to 0.58; P〈0.000 01）. Slow infusion of high-dose GM was effective for PEP prevention （OR, 0.44; 95% Cl, 0.25 to 0.79; P=0.006）, and rapid infusion of low-dose GM also showed efficacy for PEP prophylaxis （OR, 0.37; 95% C/, 0.20 to 0.69; P=0.002）. NNT was 7 and 6 respectively. However, administration of GM at low doses and by slow infusions was ineffective （OR, 0.99; 95% Cl, 0.64 to 1.55; P=0.98）. Administration of GM had the tendency to reduce PEHA rate, but not to a statistical significance （OR, 0.86; 95% CI, 0.73 to 1.01; P=0.06）. When low-quality studies were excluded, the meta-analysis with two high-quality studies indicated that ulinastatin did not reduce the rate of PEP （OR, 0.63; 95% Cl, 0.32 to 1.26; P=0.19） and PEHA incidence （OR, 0.80; 95% Cl, 0.31 to 2.07; P=0.64）. The meta-analysis with six high-quality studies showed that GM administration decreased PEP incidence （OR, 0.52; 95% CI, 0.29 to 0.91; P=-0,02）, while was not efficacious for PEHA prevention （OR, 0.88; 95% C/, 0.74 to 1.04; P=0.12）. Conclusions Ulinastatin and GM may be of value for the prophylaxis of PEP. GM should be administered at high doses and by rapid infusions. And the doses of ulinastatin should be sufficient. However, the conclusions are not overwhelming. More large-sample size and high-quality RCTs are still needed to elucidate whether administrations of the two drugs really have prophylactic effect on PEP.