仰卧位无X线监视下ICU床边急诊行内镜鼻胆管引流术治疗急性重症胆管炎  

Emergency bedside endoscopic naso-biliary drainage(ENBD)in supine position without fluoroscopy in ICU for patients with severe acute cholangitis

作　　者：杜志勇 郭跃华 DU Zhiyong;GUO Yuehua(Department of Hepatobiliary and Pancrease Surgery,Shenzhen People's Hospital,the Second Clinical Medical College of Jinan University,the First Affiliated Hospital,Southern University of Science and Technology,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院(暨南大学第二临床学院,南方科技大学第一附属医院)肝胆胰外科,518020

出　　处：《临床外科杂志》2022年第7期657-660,共4页Journal of Clinical Surgery

基　　金：2018年度深圳市卫生系统科研项目(SZLY2018006);深圳市科创委课题项目(JCYJ20190807144807510)。

摘　　要：目的 探讨仰卧位无X线监视下在ICU床边急诊行内镜鼻胆管引流术(endoscopic naso-biliary drainage, ENBD)的安全性和可行性,评价其治疗急性重症胆管炎合并感染性休克的疗效。方法 2012年1月~2018年6月收治的急性重症胆管炎合并感染性休克病人31例,均采用在ICU床边仰卧位无X线监视下急诊行ENBD治疗,分析手术成功率和临床疗效。结果 31例病人均成功实施ENBD,手术成功率100%。手术时间27.23分钟。术后病人高热、炎症和黄疸快速消退,心率和血压恢复平稳。术前、术后第1天和第2天T≥39℃病人分别为27例、2例和1例,分别占87.1%、6.5%和3.2%,术后第1天和第2天与术前比较,差异有统计学意义(P<0.05),最快HR≥100次/分病人分别为31例、8例和3例,分别占100%、25.8%和9.7%,差异有统计学意义(P<0.05);使用升压药物病人分别为31例、10例和2例,分别占100%、32.3%和6.5%,差异有统计学意义(P<0.05)。白细胞计数>20×10~9/L病人分别为28例、12例和4例,分别占90.3%、35.5%和12.9%,差异有统计学意义(P<0.05)。术前、术后第3天和术后第5天总胆红素>100μmol/L的病人分别为29例、12例和7例,占比为93.5%、38.7%和22.6%。术后第3天和术后第5天与术前比较,差异有统计学意义(P<0.05)。29例治愈,治愈率93.5%,2例死亡,死亡率6.5%。无内镜手术并发症发生。结论 仰卧位无X线监视下在ICU床边急诊行ENBD安全可行。该方法不需笨重的X线机、不需搬动病人、不需摆放体位,采用自然通道,是对病人干扰最小,创伤最轻,最灵便有效的胆道引流方法。Objective Investigate the safety,feasibility and efficacy of emergency bedside endoscopic nasobiliary drainage(ENBD)in supine position without fluoroscopy in ICU for patients with severe acute cholangitis and septic shock.Methods In total,31 patients with severe acute cholangitis underwent emergency bedside ENBD in supine position without fluoroscopy in ICU from January 2012 to June 2018.The clinical datas were reviewed and analyzed.Results Endoscopic nasobiliary drainage was successful in all 31 patients,the operation success rate was 100%,the operation time was 27.23 minutes.High fever,inflamation and jaundice were quickly degraded,and heart rate and blood pressure regained steady soon after ENBD.There were 27,2 and 1 cases of patients with high fever(T≥39℃)on three different time points(before,1day and 2 days after ENBD),respectively.The proportions were respectively 87.1%,6.5%and 3.2%(P<0.05).There were respectively 31,8 and 3 cases of patients with the fastest heart rate more than 100 beats per min on three different time points.The proportions were respectively 100%,25.8%and 9.7%(P<0.05).There were respectively 31,10 and 2 cases of patients with hypotension requiring vasopressors of any dose on three different time points.The proportions were respectively 100%,32.3%and 6.5%(P<0.05).There were respectively 28,12 and 4 cases of patients with WBC count more than 20×109/L on three different time points.The proportions were respectively 90.3%,35.5%and 12.9%(P<0.05).There were respectively 29,12 and 7 cases of patients with total bilirubin(TB)level more than 100μmol/L on three different time points(before,3 days and 5days after ENBD).The proportions were respectively 93.5%,38.7%and 22.6%.The proportions on 3days and 5days after ENBD compared with that before ENBD were declined significantly(P<0.05).Twenty-nine patients were cured.Two patients were dead,Mortality rate was 6.5%.There was no ENBD-related complications.Conclusions Emergency bedside ENBD in supine position without fluoroscopy in ICU was safe and

关 键 词：内镜下鼻胆管引流术 无X线监视 急性重症胆管炎 感染性休克 

分 类 号：R657.4[医药卫生—外科学]