[1]孙巧玲 霍天依 张四维 张志芸 周玉洁*.鼻胆管剪裁技术临床应用效果的比较研究[J].中国微创外科杂志,2022,01(2):137-141.
　Sun Qiaoling,Huo Tianyi,Zhang Siwei,et al.Comparative Study on Clinical Effect of Cutting Technique of Nasobiliary Duct[J].Chinese Journal of Minimally Invasive Surgery,2022,01(2):137-141.
点击复制

鼻胆管剪裁技术临床应用效果的比较研究()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年2期
页码:
137-141
栏目:
护理研究
出版日期:
2022-05-19

文章信息/Info

Title:
Comparative Study on Clinical Effect of Cutting Technique of Nasobiliary Duct
作者:
孙巧玲 霍天依 张四维 张志芸 周玉洁*
(北京大学第三医院普通外科，北京100191)
Author(s):
Sun Qiaoling;  Huo Tianyi;  Zhang Siwei;  et al.
Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
关键词:
内镜逆行胰胆管造影; 鼻胆管; 非计划性拔管
Keywords:
Endoscopic retrograde cholangiopancreatography; Nasobiliary duct; Unplanned Extubation
文献标志码:
A
摘要:
目的评价鼻胆管剪裁技术对内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography，ERCP)后留置鼻胆管的应用价值。方法回顾性分析2018年1月~2021年10月ERCP+十二指肠乳头括约肌切开(endoscopic sphincterotomy，EST)+鼻胆管引流术(endoscopic nasobiliary drainage，ENBD)资料。普外科病房患者79例为剪裁组，接受改良鼻胆管管理方案，将鼻胆管外露部分剪至70 cm；消化科病房患者52例为对照组，接受医院常规鼻胆管管理方案。比较2组留置鼻胆管时间、非计划性拔管风险评分以及非计划性拔管、管路不畅、术后胆管炎和胰腺炎发生率。结果剪裁组鼻胆管留置时间较对照组长［中位数3.0(1~14)d vs. 2.0(1~12)d，Z=-2.779，P=0.005］，非计划性拔管风险评分高［(4.63±135)分vs.(3.88±1.13)分，t=3.303，P=0.001］，但2组非计划性拔管率差异无显著性［0%(0/79) vs. 3.8%(2/52)，P=0156］，2组管路不畅、术后胆管炎和胰腺炎发生率差异均无显著性(P>0.05)。结论鼻胆管剪裁技术有利于降低非计划性拔管风险，规范和方便护士对鼻胆管的观察及记录，未增加术后胆管炎、胰腺炎并发症的发生率。
Abstract:
ObjectiveTo evaluate the application value of the cutting technique of nasobiliary duct in indwelling nasal bile duct after endoscopic retrograde cholangiopancreatography (ERCP).MethodsClinical data of ERCP+endoscopic sphincterotomy (EST)+endoscopic nasobiliary drainage (ENBD) from January 2018 to October 2021 were analyzed retrospectively. There were 79 patients in the General Surgery Ward included in the cutting group. They received the improved management scheme of nasobiliary duct, and the exposed part of nasobiliary duct was cut to 70 cm. There were 52 patients in the Digestive Ward served as the control group and they received our hospital’s routine nasobiliary management scheme. The time of indwelling nasobiliary duct, risk score of unplanned extubation, incidence of unplanned extubation, obstructed pipeline, postoperative cholangitis and pancreatitis were compared between the two groups.ResultsThe retention time of nasobiliary duct in the cutting group was longer than that in the control group ［3.0 (1-14) d vs. 2.0 (1-12) d, Z=-2.779, P=0.005］ and the risk score of unplanned extubation was higher ［(4.63±1.35) points vs. (3.88±1.13) points, t=3.303,P=0.001］, but there was no significant difference in the rate of unplanned extubation between the two groups ［0% (0/79) vs. 3.8% (2/52), P=0.156］. There was no significant difference in the incidence of obstructed pipeline,postoperative cholangitis and pancreatitis (P>0.05).ConclusionThe cutting technique of nasobiliary duct is helpful to reduce the risk of unplanned extubation, and standardize and facilitate nurses’ observation and recording of nasobiliary duct, and does not increase the incidence of complications of postoperative cholangitis and pancreatitis.

参考文献/References:

[1]陈思芳，李洪艳，张英.更新鼻胆管固定方法提高患者非计划性拔管的依从性.川北医学院学报,2016,31(2):254-256.
[2]王莉慧.一种新型鼻胆引流管的研制.护理学报,2017,24(24):61-62.
[3]禹雪，王玲，王丹丹，等.内镜下Oddi括约肌切开术治疗肝内外胆管结石病的疗效分析.中国微创外科杂志,2018,18(1):20-32.
[4]黄燕，傅荣，王玲玲.保持鼻胆管有效引流的护理进展.当代护士(下旬),2018,25(2):15-18.
[5]王树敏，王波，臧静.预防非计划性拔管管理策略探讨.中国医院,2021,25(7):95-96.
[6]张晓静，张会芝，周玉洁，等.住院患者非计划性拔管风险评估体系的建立.中华护理杂志,2015,50(11):1331-1334.
[7]王振文，朱亮.2019年《欧洲胃肠内镜学会指南：ERCP相关不良事件》解读.中国循证医学杂志,2020,20(6):634-642.
[8]中华医学会消化内镜学分会ERCP学组，中国医师协会消化医师分会胆胰学组，国家消化系统疾病临床医学研究中心.中国ERCP指南.中华消化内镜杂志,2018,35(11):777-813.
[9]徐平平，曾春艳，龙顺华，等.经内镜逆行胰胆管造影术后并发症的危险因素分析.中华消化内镜杂志,2017,34(10):732-737.
[10]Kim NH,Kim HJ,Bang KB.Prospective comparison of prophylactic antibiotic use between intravenous moxifloxacin and ceftriaxone for highrisk patients with postERCP cholangitis.Hepatobiliary Pancreat Dis Int,2017,16(5):512-518.
[11]Godat S,Bories E,Caillol F,et al.Efficacy and safety in case of technical success of endoscopic ultrasoundguided transhepatic antegrade biliary drainage:a report of a monocentric study.Endosc Ultrasound,2017,6(3):181-186.
[12]Wan X,Chen S,Zhao Q,et al.The efficacy of temporary placement of nasobiliary drainage following endoscopic metal stenting to prevent postERCP cholangitis in patients with cholangiocarcinoma.Saudi J Gastroenterol,2018,24(6):348-354.
[13]李姝婷，冯毕龙，喻思红.鼻胆管运用及其护理的研究进展.中华现代护理杂志,2017,23(27):3560-3564.
[14]Choudhury BN,Deka UJ,Baruah BJ,et al.Indications,outcomes and complications of therapeutic endoscopic retrograde cholangiopancreatography procedures in a tertiary care centre in North East India.Int J Res Med Sci,2020,8(7):2606-2611.
[15]Kochar B,Akshintala VS,Afghani E,et al.Incidence,severity,and mortality of postERCP pancreatitis:a systematic review by using randomized,controlled trials.Gastrointest Endosc,2014,81(1):143-149.

备注/Memo

备注/Memo:
*通讯作者，Email：yujie218@sina.com
更新日期/Last Update: 2022-05-19