朱婷　蒋志云　张文兴

〔摘要〕 目的 探讨中西医结合护理模式在内镜下胰腺包裹性坏死物质清除术中的应用。方法 10例重症胰腺炎胰腺包裹性坏死患者行内镜下包裹性坏死清创引流术，围手术期应用中西医结合的护理模式，观察治疗成功率及并发症情况。西医的特色护理主要是术中的护理配合，中医的特色护理是综合使用穴位按摩、针灸、中药等中医学手段，改善患者的术前精神状况、睡眠情况，防治术后出血、腹胀、腹痛等并发症。结果 9例经内镜治疗成功，成功率90.0%，有1例行开腹手术治疗，未发生严重并发症和死亡。结论 内镜下胰腺包裹性坏死物质清除术安全有效，中西医结合的护理模式在内镜下胰腺包裹性坏死物质清除术的围手术护理中有良好疗效。

〔关键词〕 胰腺包裹性坏死;超声内镜;内镜治疗;中西医结合护理

〔中图分类号〕R248;R657.5+1       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.01.026

〔Abstract〕 Objective To investigate the application of integrated care model of traditional Chinese and western medicine in endoscopic material removal for pancreatic encapsulated necrosis. Methods Ten patients with severe pancreatitis and pancreatic encapsulated necrosis were treated with endoscopic wrapped necrosis debridement and drainage， and the nursing mode of integrated traditional Chinese and western medicine was applied in the perioperative period， the success rate of treatment and complications were observed. The characteristic nursing of western medicine was mainly the intraoperative nursing cooperation， while the characteristic nursing of traditional Chinese medicine was the comprehensive use of acupoint massage， acupuncture， traditional Chinese medicine and other traditional Chinese medicine means to improve the preoperative mental status and sleep of patients， and prevent postoperative bleeding， abdominal distension， abdominal pain and other complications Results Nine cases were successfully treated by endoscopy， and the success rate was 90.0%. One case underwent open abdominal surgery without serious complications and death. Conclusion Endoscopic material removal for pancreatic encapsulated necrosis is safe and effective. The nursing mode of integrated traditional Chinese and western medicine has good effect in perioperative nursing of endoscopic pancreatic encapsulated necrosis material removal.

〔Keywords〕 pancreatic encapsulated necrosis; ultrasonic endoscope; endoscopic therapy; integrated traditional Chinese and western medicine nursing

胰腺包裹性壞死是一种包含胰腺和（或）胰周坏死组织且具有界限清晰炎性包膜的囊实性结构，多发生于急性重症胰腺炎起病4周后，是最严重的并发症之一，病死率高[1]。外科开放清创引流术曾是唯一的治疗手段，但该治疗方式创伤大、并发症多、死亡率高。现阶段主要治疗方法包括经皮穿刺置管引流、内镜辅助下腹膜后清创、腹腔镜清创引流和经胃内镜下清创引流。内镜下经胃清创引流是目前较为新颖的一项技术，相比经皮穿刺引流，具有引流更加彻底，对于黏稠的坏死物质具有较好的清除及引流效果;相较于腹腔镜入路，内镜入路具有更加微创的优点[2]。……