内镜下食管静脉曲张套扎术治疗食管胃底静脉曲张破裂的护理干预(1)
[摘要] 目的 探讨护理干预在食管静脉曲张破裂出血内镜下食管静脉曲张套扎术(endoscope variceal figadon，EVL)治疗中的作用。 方法 回顾性分析本院2008年6月～2011年6月收治的116例食管静脉曲张患者内镜下行食管静脉曲张套扎术(EVL)的治疗和护理资料。 结果 本组116例患者中，110例第1次套扎达到止血效果，止血率为94.8%；有4例第1次套扎术后再次出血，经再次套扎后，未再出血，发生率为3.4%；有2例第1次套扎术后再次出血，经再次套扎后，配合H2受体阻滞剂治疗未再出血，发生率为1.7%。套扎术治疗后2周，所有患者均按时复查，其中4例食管曲张静脉消失，109例患者食管曲张静脉均有不同程度的减轻，3例食管曲张静脉再出血者行了二次套扎治疗。 结论 全面细致地做好术前准备、术中配合、术后护理有助于提高手术效果、减少并发症。
[关键词] 食管静脉曲张；套扎术；护理；因素
[中图分类号] R473.5 [文献标识码] A [文章编号] 1674-4721(2012)02(c)-0140-02
, http://www.100md.com
Nursing intervention of endoscopic esophageal variceal ligation in the treatment of esophageal variceal bleeding
XU Yinghua CHEN Fubo LIU Weilin
Daojiao Hospital of Dongguan City in Guangdong Province, Dongguan 523176, China
[Abstract] Objective To investigate the effect of nursing intervention of endoscopic esophageal variceal ligation (EVL) in the treatment of esophageal variceal bleeding. Methods Treatment and care data of 116 cases of patients who were treated with EVL were analyzed retrospectively in our hospital from June 2008 to June 2011. Results Among 116 cases, 110 cases reached the effect of first ligation hemostasis, and the hemostasis rate was 94.8%. 4 cases had re-bleeding after the first ligation and were treated with re-ligation, who had no further bleeding, the occurrence was 3.4%. 2 cases had re-bleeding after the first ligation and were treated with re-ligation combined with H2 receptor blockers, who had no further bleeding, the occurrence rate was 1.7%. 2 weeks after EVL treatment, all patients were reviewed on time, esophageal varices was disappeared in 4 cases, which was lightened of varying degrees in 109 cases, and 3 cases of esophageal variceal re-bleeding patients were treated with a second ligation. Conclusion The comprehensive and meticulous preoperative preparation, intraoperative cooperation and postoperative care can help to improve the surgical effects and reduce complication.
, 百拇医药
[Key words] Esophageal varices; Ligation; Care; Factor
食管胃底静脉曲张破裂出血是肝硬化最常见的并发症和重要死亡原因，随着近年来医学的不断发展、进步，内镜下食管静脉曲张套扎术(endoscope variceal figadon，EVL)已成为一种新型的治疗方法，用于预防和治疗食管静脉曲张破裂出血[1]。此方法与传统的硬化疗法相比，具有操作简便、疗效确切、并发症少、可重复治疗等优点。既可急症出血，又可防治再出血。做好护理是促进疾病好转、防止再次出血的重要措施之一。
1 资料与方法
1.1 一般资料
选取本院2008年6月～2011年6月内镜下套扎治疗的肝硬化食管静脉曲张出血116例。镜下表现根据中华消化内镜学会2000年3月制定的食管胃底静脉曲张内镜下分级标准分级[2]：食管静脉曲张轻度4例，中度42例，重度70例。 116例患者中，男86例，女30例。年龄18～70岁，平均51.5岁。其中，呕血70例，黑便31例，呕血及黑便9例。合并腹水30例，黄疸27例。116例中，肝炎后肝硬化82例，酒精性肝硬化17例，原发性肝癌8例，隐源性肝硬化7例，特发性门脉高压术后1例，原发性胆汁淤积性肝硬化1例。肝功能child-pugh分级：A级27例，B级60例，C级29例。
, 百拇医药
1.2 护理措施
1.2.1 术前护理 由于患有本病的患者病史较长，均有出血和大出血的经历，对疾病本身有一种恐惧感，甚至对治疗缺乏信心。加之对EVL的治疗认识的匮乏，极度容易产生恐惧甚至抵触的情绪。因此，术前护理人员需要耐心、详细地向患者本人及其家属讲解，使其能够充分了解到治疗的优点和疗效，如何配合EVL治疗以及术中的注意事项，并可以通过列举以往成功病例来增强患者信心，积极主动地接受治疗。患者或其家属同意后，签署手术知情同意书，此后护理人员需为患者做下一步术前详细准备：(1)术前禁食、禁水6～8 h，术前采血检查血常规、出凝血时间。(2)对有失血休克者及时纠正，有肝性脑病患者先纠正至意识清醒，有凝血酶原时问明显延长者给予大量补充维生素K，为进行套扎创造条件[5]。
1.2.2 术中护理 协助患者摆好体位，插镜过程中密切观察患者颜面、血压和脉搏的变化，对恶心者嘱其深呼吸以减轻症状，有呕吐者应保持呼吸道通畅，防止误吸。注意观察呕吐物性状，若为血性，需及时、冷静处理。嘱患者手术过程中如有不适，可用手示意，并进行适当言语鼓励及安慰[6]。术者套扎时，护士应严密观察患者状态及检测仪上生命体征变化，防止出现咬胃镜、窒息、大出血等意外发生。, 百拇医药(徐映华 陈伏波 刘伟林)
[关键词] 食管静脉曲张；套扎术；护理；因素
[中图分类号] R473.5 [文献标识码] A [文章编号] 1674-4721(2012)02(c)-0140-02
, http://www.100md.com
Nursing intervention of endoscopic esophageal variceal ligation in the treatment of esophageal variceal bleeding
XU Yinghua CHEN Fubo LIU Weilin
Daojiao Hospital of Dongguan City in Guangdong Province, Dongguan 523176, China
[Abstract] Objective To investigate the effect of nursing intervention of endoscopic esophageal variceal ligation (EVL) in the treatment of esophageal variceal bleeding. Methods Treatment and care data of 116 cases of patients who were treated with EVL were analyzed retrospectively in our hospital from June 2008 to June 2011. Results Among 116 cases, 110 cases reached the effect of first ligation hemostasis, and the hemostasis rate was 94.8%. 4 cases had re-bleeding after the first ligation and were treated with re-ligation, who had no further bleeding, the occurrence was 3.4%. 2 cases had re-bleeding after the first ligation and were treated with re-ligation combined with H2 receptor blockers, who had no further bleeding, the occurrence rate was 1.7%. 2 weeks after EVL treatment, all patients were reviewed on time, esophageal varices was disappeared in 4 cases, which was lightened of varying degrees in 109 cases, and 3 cases of esophageal variceal re-bleeding patients were treated with a second ligation. Conclusion The comprehensive and meticulous preoperative preparation, intraoperative cooperation and postoperative care can help to improve the surgical effects and reduce complication.
, 百拇医药
[Key words] Esophageal varices; Ligation; Care; Factor
食管胃底静脉曲张破裂出血是肝硬化最常见的并发症和重要死亡原因，随着近年来医学的不断发展、进步，内镜下食管静脉曲张套扎术(endoscope variceal figadon，EVL)已成为一种新型的治疗方法，用于预防和治疗食管静脉曲张破裂出血[1]。此方法与传统的硬化疗法相比，具有操作简便、疗效确切、并发症少、可重复治疗等优点。既可急症出血，又可防治再出血。做好护理是促进疾病好转、防止再次出血的重要措施之一。
1 资料与方法
1.1 一般资料
选取本院2008年6月～2011年6月内镜下套扎治疗的肝硬化食管静脉曲张出血116例。镜下表现根据中华消化内镜学会2000年3月制定的食管胃底静脉曲张内镜下分级标准分级[2]：食管静脉曲张轻度4例，中度42例，重度70例。 116例患者中，男86例，女30例。年龄18～70岁，平均51.5岁。其中，呕血70例，黑便31例，呕血及黑便9例。合并腹水30例，黄疸27例。116例中，肝炎后肝硬化82例，酒精性肝硬化17例，原发性肝癌8例，隐源性肝硬化7例，特发性门脉高压术后1例，原发性胆汁淤积性肝硬化1例。肝功能child-pugh分级：A级27例，B级60例，C级29例。
, 百拇医药
1.2 护理措施
1.2.1 术前护理 由于患有本病的患者病史较长，均有出血和大出血的经历，对疾病本身有一种恐惧感，甚至对治疗缺乏信心。加之对EVL的治疗认识的匮乏，极度容易产生恐惧甚至抵触的情绪。因此，术前护理人员需要耐心、详细地向患者本人及其家属讲解，使其能够充分了解到治疗的优点和疗效，如何配合EVL治疗以及术中的注意事项，并可以通过列举以往成功病例来增强患者信心，积极主动地接受治疗。患者或其家属同意后，签署手术知情同意书，此后护理人员需为患者做下一步术前详细准备：(1)术前禁食、禁水6～8 h，术前采血检查血常规、出凝血时间。(2)对有失血休克者及时纠正，有肝性脑病患者先纠正至意识清醒，有凝血酶原时问明显延长者给予大量补充维生素K，为进行套扎创造条件[5]。
1.2.2 术中护理 协助患者摆好体位，插镜过程中密切观察患者颜面、血压和脉搏的变化，对恶心者嘱其深呼吸以减轻症状，有呕吐者应保持呼吸道通畅，防止误吸。注意观察呕吐物性状，若为血性，需及时、冷静处理。嘱患者手术过程中如有不适，可用手示意，并进行适当言语鼓励及安慰[6]。术者套扎时，护士应严密观察患者状态及检测仪上生命体征变化，防止出现咬胃镜、窒息、大出血等意外发生。, 百拇医药(徐映华 陈伏波 刘伟林)