球囊扩张治疗食管静脉曲张硬化术后狭窄的护理  

Nursing care of patients with esophageal varices stenosis after balloon dilatation

作　　者：王录洁 张丽[1] 张月宁[1] Wang Lujie;Zhang Li;Zhang Yuening(Beijing You'an Hospital,Capital Medical University,Beijing,100069,China)

机构地区：[1]首都医科大学附属北京佑安医院,北京100069

出　　处：《医院与医学》2020年第3期41-43,55,共4页Hospital and Medicine

基　　金：北京市医院管理中心消化内科学科协同发展中心专项经费资助(XXZ0403)。

摘　　要：总结14例静脉麻醉、X线监测、胃镜直视下球囊扩张术治疗食管静脉曲张硬化剂治疗术后狭窄的护理要点。食管静脉曲张硬化术后食管狭窄发生率为2.8%。本组实施球囊扩张38次,初次疗程扩张2.4±0.3次/例,全部达到治疗目的。2例3月后再狭窄而需第二疗程扩张;1例因反复再狭窄共行4疗程治疗。扩张造成狭窄处糜烂及渗血,术前、术后使用血凝酶及球囊本身压迫均可止血。1例术后大出血(7.1%),急诊胃镜及内科综合治疗后痊愈。术后发热4例(28.6%),2例需抗生素治疗。加强术前评估与访视,心理支持,做好相关设备、器械及药品准备,术中监护、防止误吸,默契操作配合,术后监护与并发症观察处理,可明显提高扩张效果并保证医疗安全。This paper summarized the nursing points of 14 patients undergoing intravenous anesthesia,X-ray monitoring balloon dilation endoscopically for esophageal stenosis caused by sclerotherapy of varices.The incidence of esophageal stricture after endo⁃scopic sclerotherapy was 2.8%.Balloon dilatation was performed 38 times in this group.After the initial course of dilation(2.4±0.3 times per case),esophageal stricture was alleviated significantly.Two patients had restenosis after 3 months and needed a second course of dilatation.One patient needed 4 courses of treatment because of recurrent stricture.Expansion resulted in erosion and bleeding,but hemostasis could be achieved easily by use of hemagglutinin before and after operation and the compression of the balloon itself.One case(7.1%)had massive hemorrhage after dilation and was cured through emergency gastroscopy and comprehensive medical treatment.Postoperative fever occurred in 4 cases(28.6%)and antibiotics were needed in 2 cases.Preoperative visitation and fully assessment,psy⁃chological support,detailed preparation of instruments,intraoperative monitoring,prevention of aspiration,tacit cooperation,intensively observation and management of postoperative complications can significantly improve the expansion effect and ensure medical safety.

关 键 词：食管狭窄 球囊扩张术 静脉曲张 麻醉 X线 护理 

分 类 号：R47[医药卫生—护理学]