老年ERCP术后患者非计划性拔管的影响因素分析  

Analysis of factors influencing unplanned extubation of nasobiliary drainage tubes in elderly patients after ERCP

作　　者：王洁 莫文娟[1] 李嘉琪[1] 王一棋 WANG Jie;MO Wenjuan;LI Jiaqi;WANG Yiqi(School of Nursing,University of South China,Hengyang,Hunan 421001,China;Department of Hepatobiliary Surgery,The First Affiliated Hospital of South China University,Hengyang,Hunan 421001,China)

机构地区：[1]南华大学护理学院,湖南衡阳421001 [2]南华大学附属第一医院肝胆外科,湖南衡阳421001

出　　处：《现代医药卫生》2025年第3期725-728,735,共5页Journal of Modern Medicine & Health

摘　　要：目的 探讨老年胆总管结石患者内镜下逆行胰胆管造影(ERCP)术后非计划性鼻胆管拔管的现状及其影响因素,并提出预防策略。方法 选取2017年1月至2024年6月南华大学附属第一医院肝胆外科收治的442例ERCP术后留置鼻胆管的老年胆总管结石患者,按照是否发生非计划性拔管将患者分为拔管组(43例)和未拔管组(399例),比较2组患者疼痛程度[采用视觉模拟评分法(VAS)]、陪护情况、健康教育及相关健康指标等情况,采用logistic回归模型分析患者发生非计划性鼻胆管拔管的影响因素。结果 拔管组患者意识状态、健康教育、陪护情况、VAS评分与未拔管组比较,差异均有统计学意义(P<0.05);疼痛感、无陪护、意识不清及未接受健康教育为非计划性鼻胆管拔管的影响因素(优势比大于1,P<0.05)。结论 疼痛感、有无陪护、意识不清和健康教育是老年ERCP患者非计划性鼻胆管拔除的主要影响因素;医护人员应高度重视此类患者的疼痛护理,做好患者及陪护的相关培训,以防止非计划性拔管。Objective To explore the current status and influencing factors of unplanned extubation of nasobiliary drainage tubes in elderly patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography(ERCP)and to propose preventive strategies.Methods A total of 442 elderly patients with choledocholithiasis who underwent ERCP and had nasobiliary drainage tubes placed postoperatively in the Department of Hepatobiliary Surgery at the First Affiliated Hospital of University of South China from January 2017 to June 2024 were selected.Patients were divided into an extubation group(43 cases)and a non-extubation group(399 cases)based on whether unplanned extubation occurred.The two groups were compared in terms of pain intensity[assessed using the Visual Analog Scale(VAS)],companionship status,health education,and related health indicators.Logistic regression analysis was conducted to identify factors influencing unplanned extubation of nasobiliary drainage tubes.Results Statistically significant differences were observed between the extubation group and the non-extubation group in terms of consciousness,health education,companionship status,and VAS scores(P<0.05).Pain perception,lack of companionship,unconsciousness,and not receiving health education were identified as influencing factors for unplanned extubation of nasobiliary drainage tubes(odds ratio>1,P<0.05).Conclusion Pain perception,companionship status,unconsciousness,and health education are major influencing factors for unplanned extubation of nasobiliary drainage tubes in elderly patients after ERCP.Healthcare providers should attach great importance to pain management in such patients and provide adequate training for patients and their companions to prevent unplanned extubation.

关 键 词：胆总管结石 内镜下逆行胰胆管造影 非计划性拔管 鼻胆管 影响因素分析 

分 类 号：R657.4[医药卫生—外科学]