内镜下逆行胰胆管造影术后并发症发生的原因分析与护理对策

目的探讨内镜下逆行胰胆管造影(ERCP)术后并发症发生的原因及相关护理对策。方法选取2018年1月至2019年9月在我院行ERCP患者394例为研究对象,查阅病历资料,获取并发症发生情况。结果本组患者术后有55例出现并发症,发生率13.96%,其中胰腺炎33例,均为内镜下十二指肠乳头括约肌切开术(EST)和鼻胆管引流术(ENBD),7例既往有胰腺炎病史,7例反复插管(>5次),5例手术时间>1 h,7例胰管显影,15例为术后反复取石、多发结石,3例合并胰管结石;消化道出血12例,均行EST,8例合并十二指肠乳头旁憩室;胆道感染7例,均行EST+网篮取石+ENBD手术,既往有胆管炎病史;肝内胆管穿孔3例,因胆总管结石进行EST+网篮取石+ENBD手术。结论ERCP术后并发症发生率较高,应加强防范,注重规范化培训,降低并发症发生率。

Analysis of the causes of complications after endoscopic retrograde cholangiopancreatography and its nursing countermeasures

Objective To explore the causes of complications after endoscopic retrograde cholangiopancreatography(ERCP)and its related nursing countermeasures.Methods To select 394 cases of patients with ERCP who were treated in our hospital from January 2018 to September 2019 as the study objects.The medical records were reviewed to obtain the occurrence dynamics of complications.Results There were 55 cases of complications in patients of this group,the incidence was 13.96%,of which 33 cases of pancreatitis were endoscopic sphincterotomy(EST)and endoscopic nasobiliary drainage(ENBD),7 cases had a previous history of pancreatitis,and 7 cases were repeatedly intubated(>5 times).The operation time of 5 cases was more than 1 hour,7 cases had pancreatic duct imaging,15 cases had repeated stone removal and multiple stones,3 cases had concurrent pancreatic duct stones;12 cases had gastrointestinal bleeding,all had EST,and 8 cases had concurrent juxta-papillary duodenal diverticula;7 cases of biliary tract infections,all of them underwent EST+net basket stone removal+ENBD surgery,with a previous history of cholangitis;3 cases of intrahepatic bile duct perforation,EST+net basket stone removal+ENBD surgery for common bile duct stones.Conclusion The incidence of postoperative complications of ERCP was high.Prevention should be strengthened,and standardized training should be emphasized to reduce the incidence of complications.