腹腔灌洗在急性重症胰腺炎治疗中的应用及护理

蚁璇??陈键林

[摘要] 目的 观察腹腔灌洗在急性重症胰腺炎治疗中的效果与护理要点。 方法 对41例应用腹腔灌洗治疗重症急性胰腺炎患者进行全面而细致的护理，同时我们选取了既往急性重症胰腺无进行腹腔灌洗的患者40例，回顾其资料，比较两组在术后恢复及并发症等方面，也总结护理经验，归纳相关护理要点。 结果 41例患者中1例因症状加重后自动出院，其余都治愈出院，死亡率较既往资料明显下降。患者治疗后腹胀和腹痛缓解时间为（4.12±2.67）d，SIRS改善时间为（5.01±2.37）d，住院时间为（26.63±12.74）d，10例患者出现并发症，与以往资料相比较，均明显下降（P<0.05）；血淀粉酶恢复正常时间、两组治疗后第3天、第7天CRP值也存在差异（P<0.05）。两组APACHEⅡ分值第3天无明显差异，第7天则存在明显统计学意义。 结论 腹腔灌洗治疗能有效提高SAP的治愈率。治疗过程中，护理人员应做好患者心理护理、严密观察病情和细心做好腹腔灌洗的护理，积极预防腹腔灌洗相关并发症。

[关键词] 重症急性胰腺炎；腹腔灌洗；治疗效果；护理要点

[中图分类号] R459.7 [文献标识码] A [文章编号] 2095-0616（2017）12-104-04

Application and nursing of peritoneal lavage in treatment of severe acute pancreatitis

YI Xuan CHEN Jianlin

Operating Room，Shantou Central Hospital，Shantou 515000，China

[Abstract] Objective To observe the curative effect and nursing points of peritoneal lavage in treatment of severe acute pancreatitis. Methods 41 patients with severe acute pancreatitis who were treated by peritoneal lavage were given comprehensive and careful nursing.In addition，40 patients with severe acute pancreatitis who were not given peritoneal lavage were also selected.Data of them were retrospectively analyzed.Postoperative recovery，complications and other aspects of two groups were compared.Nursing experience was concluded and relative nursing points were summarized. Results In 41 patients，1 case was voluntarily discharged because of aggravated symptoms and others were cured and discharged.Mortality rate was significantly decreased compared with previous data. After treatment，remission time for abdominal distension and abdominal pain，improvement time for SIRS and hospitalization stay of patients were respectively（4.12±2.67），（5.01±2.37） and （26.63±12.74）d.10 patients had complications and complications were significantly reduced compared with previous data.Time of recovery of blood amylase，CRP level of the third day after treatment and CRP level of the seventh day after treatment all had difference（P<0.05）.APACHEⅡscore of the third day between two groups had no significant difference but that of the seventh day had statistical significance. Conclusion Peritoneal lavage can effectively improve cure rate of SAP.During treatment，nursing staff should offer psychological nursing，carefully observe the disease，carefully provide nursing of peritoneal lavage and positive prevent related complications of peritoneal lavage.

[Key words] Severe acute pancreatitis；Peritoneal lavage；Curative effect；Nursing points

急性重癥胰腺炎（SAP）是起病急、进展快、并发症多、死亡率高的高危急腹症。全球每年每1百万人口就有4.9～73.4人发生急性重症胰腺炎[1-2]，在美国每年直接花费超过20亿美元[3]。近年来，尽管随着对疾病的认识以及重症监护技术的发展，重症急性胰腺炎死亡率仍高达20%[4]。经过大量的研究和临床资料表明，不论哪种发展到多脏器功能衰竭 （MODS）都存在着一条共有的通路，即系统性炎

症反应综合征（SIRS）。SAP自然发展的急性炎症反应期就是以炎症因子及炎症介质引发的SIRS为主要表现，可导致出现单个或多个器官功能障碍甚至衰竭，在胰腺感染期，出现胰腺感染、脓肿形成及进一步的器官功能衰竭。SAP的病理生理过程中大量腹腔积液/胰腺坏死以及感染起着重要的作用[5-6]。……