优化食管胃静脉曲张破裂出血患者救护管理方案的实践

doi:10.3761/j.issn.2096-7446.2023.02.014

摘要/Abstract

摘要： 目的开展肝硬化食管胃静脉曲张破裂出血患者救护管理方案的优化实践。方法成立多学科救护小组,分析救护过程中存在的问题,从紧急病情评估和护理、容量复苏、急诊药物止血、内镜止血、急诊转运多方面优化举措,并进行质量控制,在急诊科开展实践。结果 15例患者均止血成功,住院时间为（7.73±3.13） d,较文献报告的肝硬化食管胃底静脉曲张出血胃镜治疗患者的住院时间（12.50±2.50） d明显缩短。结论优化肝硬化食管胃静脉曲张破裂出血患者救护管理方案有助于缩短患者住院时间。

关键词: 食管和胃静脉曲张, 出血, 急症护理, 救护方案

Abstract: Objective To carry out the practice of optimized rescue and nursing management plan for patients with esophagogastric variceal bleeding in liver cirrhosis. Methods A multidisciplinary rescue and nursing team was established,the problems in the rescue process was analyzed,and the measures was optimized from emergency condition assessment and nursing,volume resuscitation,emergency drug hemostasis,endoscopic hemostasis,emergency transport,and quality control was carried out and the management plan was practiced in the emergency department. Results Hemostasis was successful in all 15 patients. The length of hospital stay was （7.73±3.13） days,which was significantly shorter than that of patients with esophagogastric variceal bleeding in liver cirrhosis reported in the literature（12.5±2.5） days. Conclusion Optimizing the rescue and nursing management plan for patients with esophagogastric variceal bleeding in liver cirrhosis can shorten the hospital stay length of patients.

Key words: Esophageal and Gastric Varices, Hemorrhage, Emergency Nursing, Rescue and Nursing Management Plan

吕敏芳, 朱英华, 张双燕, 韦炜. 优化食管胃静脉曲张破裂出血患者救护管理方案的实践[J]. 中华急危重症护理杂志, 2023, 4(2): 158-162.

LÜ Minfang, ZHU Yinghua, ZHANG Shuangyan, WEI Wei. The practice of optimized rescue and nursing management plan for esophagogastric variceal bleeding[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(2): 158-162.

参考文献

[1] Song JE,Kim BS.Endoscopic therapy and radiologic intervention of acute gastroesophageal variceal bleeding[J]. Clin Endosc,2019,52(5):407-415.
[2] Kovalak M,Lake J,Mattek N,et al.Endoscopic screening for varices in cirrhotic patients:data from a national endoscopic database[J]. Gastrointest Endosc,2007,65(1):82-88.
[3] Gazzera C,Righi D,Doriguzzi Breatta A,et al.Emergency transjugular intrahepatic portosystemic shunt(TIPS):results,complications and predictors of mortality in the first month of follow-up[J]. Radiol Med,2012,117(1):46-53.
[4] 韦炜,洪依萍. CT辅助下食管胃静脉曲张内镜下诊疗技巧[M]. 沈阳:辽宁科学技术出版社,2021.
Wei W,Hong YP.Endoscopic diagnosis and treatment of eso-phageal and gastric varices assisted by CT[M]. Shenyang:Liao-ning Science and Technology Press,2021.
[5] 中华医学会外科学分会脾及门静脉高压外科学组. 肝硬化门静脉高压症食管、胃底静脉曲张破裂出血诊治专家共识(2019版)[J]. 中国实用外科杂志,2019,39(12):1241-1247.
Splenic and Portal Hypertension Surgery Group of Surgical Committee of Chinese Medical Association. Expert consensus on diagnosis and treatment of esophageal and gastric variceal rupture and bleeding in cirrhotic portal hypertension(2019 Edition)[J]. Chin J Pract Surg,2019,39(12):1241-1247.
[6] 李伟健. 不同时机行急诊胃镜对肝硬化相关食管胃底静脉曲张破裂出血的干预效果[J]. 广西医学,2020,42(16):2104-2107.
Li WJ.Intervention effects of emergency gastroscopy at different timing on cirrhosis-associated esophageal and gastric vari-ceal bleeding[J]. Guangxi Med J,2020,42(16):2104-2107.
[7] 中华医学会肝病学分会. 肝硬化肝性脑病诊疗指南(2018年,北京)[J]. 中华胃肠内镜电子杂志,2018,5(3):97-113.
Hepatology Committee of Chinese Medical Association. Guidelines for the diagnosis and treatment of hepatic encephalopathy with cirrhosis(2018,Beijing)[J]. Chin J Gastrointestinal Endoscopy(Electronic Edition),2018,5(3):97-113.
[8] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J]. 临床肝胆病杂志,2016,32(2):203-219.
Hepatology Committee of Chinese Medical Association,Gastroenterology Committee of Chinese Medical Association,Chinese Medical Association,Endoscopy Committee of Chinese Medical Association. Guidelines for the diagnosis and treatment of esophageal and gastric variceal bleeding in cirrhotic portal hypertension[J]. J Clin Hepatol,2016,32(2):203-219
[9] Tripathi D,Stanley AJ,Hayes PC,et al.U.K. Guidelines on the management of variceal haemorrhage in cirrhotic patients[J]. Gut,2015,64(11):1680-1704.
[10] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志,2019,27(11):846-865.
Chinese Society of Hepatology,Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. Chin J Hepatol,2019,27(11):846-865.
[11] 徐军,戴佳原,尹路. 急性上消化道出血急诊诊治流程专家共识[J]. 中国急救医学,2021,41(1):1-10.
Xu J,Dai JY,Yin L.Expert consensus on emergency diagnosis and treatment of acute upper gastrointestinal bleeding[J]. Chin J Crit Care Med,2021,41(1):1-10.
[12] Korean Association for the Study of the Liver(KASL). KASL clinical practice guidelines for liver cirrhosis:Varices,hepatic encephalopathy,and related complications[J]. Clin Mol Hepatol,2020,26(2):83-127.
[13] Yoshiji H,Nagoshi S,Akahane T,et al.Evidence-based clinical practice guidelines for Liver Cirrhosis 2020[J]. J Gastroenterol,2021,56(7):593-619.
[14] Chapman W,Siau K,Thomas F,et al.Acute upper gastrointestinal bleeding:a guide for nurses[J]. Br J Nurs,2019,28(1):53-59.
[15] Stanley AJ,Laine L.Management of acute upper gastrointestinal bleeding[J]. BMJ,2019,364:l536.
[16] Garcia-Tsao G,Abraldes JG,Berzigotti A,et al.Portal hypertensive bleeding in cirrhosis:risk stratification,diagnosis,and management:2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology,2017,65(1):310-335.
[17] 赵春华,张小伟,任玉芝. 危重症患者院内安全转运发生血氧饱和度降低的影响因素分析[J]. 齐鲁护理杂志,2021,27(15):140-142.
Zhao CH,Zhang XW,Ren YZ.Analysis on the influencing factors of oxygen saturation decrease in critically ill patients during safe transport in hospital[J]. J Qilu Nurs,2021,27(15):140-142.
[18] 任素芳,张丽,褚敏. 肝硬化食管胃底静脉曲张出血的胃镜治疗效果分析[J]. 中国药物与临床,2020,20(24):4074-4076.
Ren SF,Zhang L,Chu M.Effect of gastroscopic treatment of esophageal and gastric varices bleeding in liver cirrhosis[J].Chin Rem Clin,2020,20(24):4074-4076.
[19] 周林峰,王万胜,朱晓黎. 建立肝硬化门静脉高压食管胃底静脉曲张破裂出血急诊绿色通道的可行性、安全性及有效性[J]. 临床肝胆病杂志,2019,35(5):996-1001.
Zhou LF,Wang WS,Zhu XL.Feasibility,safety and effectiveness of establishing emergency green channel for esophageal and gastric varices rupture bleeding in cirrhosis[J]. J Clin He-patol,2019,35(5):996-1001.