ERCP术后并发胆道出血的危险因素及防护  

Exploration of risk factors and preventive measures for patients with bile-duct haemorrhage after ERCP

作　　者：李俊梅[1] 李芸[1] 魏芳[1] 

机构地区：[1]四川大学华西医院金卡病房,四川成都610041

出　　处：《西部医学》2012年第3期600-602,共3页Medical Journal of West China

摘　　要：目的探讨经内镜逆行胰胆管造影(ERCP)术后胆道出血的危险因素和预防措施。方法采用回顾性调查方法对施行ERCP术治疗的628例病人进行分析,探讨术后36例并发胆道出血患者的处理和危险因素。结果 ER-CP术后发生胆道出血的危险因素主要有:①出凝血时间延长、血小板计数减少。②原发病因素:患胆总管多发结石、胆道系统肿瘤、乳头旁有憩室或憩室内乳头患者ERCP术后胆道出血发生率增高(P<0.05)。③手术方式:采用针状刀切开技术出血发生率高于弓形切开刀技术(P<0.05)。出血的防护措施主要包括:做好心理护理;术前充分评估并完善术前准备;做好术中和术后护理。做好并发出血的紧急处理:①内镜下喷药、止血夹、电凝及注射等方式止血。②鼻胆管内去甲肾上腺素盐水冲洗。③血管介入栓塞治疗。④静脉输入止血药并快速补液治疗。结论 ERCP术后可并发胆道出血,通过有效的防护措施,可以减少ERCP术后胆道出血的发生,减少病人痛苦。Objective To explore some risk factors and preventive measures of bile-duct haemorrhage of patients after ERCP.Methods Author reviewed 628 patients＇ data which accepted ERCP therapy during 3 years,and got 36 patients＇ data who occurred bile-duct haemorrhage after ERCP.Some risk factors and preventive measure of bile-duct haemorrhage were analyzed and dicussed.Results The risk factors included： ① Abnormal function of cruor,such as Prolonged time of bleeding-cruor or lessened amount of blood platelet;② Primary disease： more stone in the largest bile-duct,tumor of gallbladder system,diverticulum nearby nipple of duodenum or nipple in diverticulum were easy to occur haemorrhage（P0.05）;③ Operation manner： It was higher to take place haemorrhage after ERCP by technique with needle-style knife than with arc-style knife（P0.05）.Preventive measures mainly included psychologic care,sufficient estimation and preparation before operation,perfect care given during and after operation,rightly dealing with the haemorrhage.Conclusion The haemorrhage of bile-duct after ERCP can be prevented by effective measures which were summarized from risk factors.

关 键 词：内镜下逆行胰胆管造影 胆道出血 危险因素 护理 

分 类 号：R445[医药卫生—影像医学与核医学]