Nursing cooperation for internal and external stent replacement in a special retrograde cholangiopancreatography operation
1例特殊逆行胰胆管造影操作内外支架置换术护理配合

摘要

总结1例特殊逆行胰胆管造影（ERCP）手术操作内外支架置换术的护理配合体会。护理要点包括术前认知教育联合负性情绪疏导；顺行导丝插入配合；取出牵引导丝配合；逆行胆道支架置入配合；PTCD管路管理；术中体位变换与管理；术中呼吸观察与处理。给予患者术前认知教育，能够提高患者对疾病和手术的认识，减少因未知产生的恐惧感；心理疏导可改善患者的负性情绪，使其保持乐观的心态面对疾病治疗；顺行导丝插入配合能够保证导丝顺利插入，减少患者的痛苦；而取出牵引导丝配合、逆行胆道支架置入配合、PTCD管路管理、术中体位变换与管理、术中呼吸观察与处理等护理措施的应用，对于手术的顺利进行、手术的安全性以及手术预后的改善，具有十分重要的意义。患者术中拔除引流管，胆道支架置入成功，术后第五日出院，随访6个月，肝功能指标尚可，体重增加2.2公斤。

Abstract

Summarizes the experience of nursing cooperation for internal and external stent replacement in a special retrograde cholangiopancreatography (ERCP) operation. The key points of nursing include preoperative cognitive education combined with negative emotion counseling; cooperation with antegrade guidewire insertion; cooperation with removal of traction guidewire; cooperation with retrograde biliary stent placement; PTCD pipeline management; intraoperative body position change and management; intraoperative respiratory observation and treatment. Giving patients preoperative cognitive education can improve their understanding of the disease and surgery and reduce the fear caused by the unknown; psychological counseling can improve the negative emotions of patients and keep them optimistic about the treatment of the disease; cooperation with antegrade guidewire insertion can ensure the smooth insertion of the guidewire and reduce the pain of patients; and the application of nursing measures such as cooperation with removal of traction guidewire, cooperation with retrograde biliary stent placement, PTCD pipeline management, intraoperative body position change and management, intraoperative respiratory observation and treatment, etc., is of great significance for the smooth progress of the operation, the safety of the operation and the improvement of surgical prognosis. The patient had the drainage tube removed during the operation, and the biliary stent was successfully placed. He was discharged from the hospital on the fifth day after the operation. During the 6-month follow-up, his liver function index was acceptable and his weight increased by 2.2 kg.