CAJ | 학술논문

目的：探讨胆道支架联合125I粒子条治疗恶性梗阻性黄疸的护理。方法对41例恶性梗阻性黄疸患者行胆道支架联合125I粒子条植入术，术前做好心理干预与术前准备；术中配合医师手术操作、观察患者生命体征变化及恶心呕吐等处理；术后加强PTCD引流管管理、辐射防护及并发症的观察和护理。结果胆道支架联合125I粒子条植入成功率100%；比较术前、术后1周、1个月、3个月总胆红素，黄疸基本缓解；并发症计发生胆心反射1例、PTCD引流管移位2例，术后畏寒、发热12例，急性肾功能不全1例，经有效处理后缓解；患者中位生存时间为10.9个月。结论术前周密的准备可确保治疗顺利进行；术中护士密切观察、熟练掌握配合；术后密切观察、精心护理，早发现、早处理并发症，可让患者安全度过康复期。
목적：탐토담도지가연합125I입자조치료악성경조성황달적호리。방법대41례악성경조성황달환자행담도지가연합125I입자조식입술，술전주호심리간예여술전준비；술중배합의사수술조작、관찰환자생명체정변화급악심구토등처리；술후가강PTCD인류관관리、복사방호급병발증적관찰화호리。결과담도지가연합125I입자조식입성공솔100%；비교술전、술후1주、1개월、3개월총담홍소，황달기본완해；병발증계발생담심반사1례、PTCD인류관이위2례，술후외한、발열12례，급성신공능불전1례，경유효처리후완해；환자중위생존시간위10.9개월。결론술전주밀적준비가학보치료순리진행；술중호사밀절관찰、숙련장악배합；술후밀절관찰、정심호리，조발현、조처리병발증，가양환자안전도과강복기。
Objective To discuss the nursing points for patients with malignant obstructive jaundice who are receiving biliary stenting combined with linear 125I seeds strand implantation. Methods A total of 41 patients with malignant obstructive jaundice were enrolled in this study. Biliary stenting combined with linear 125I seeds strand implantation was performed in all the 41 patients. Sufficient preoperative preparation and psychological intervention were carefully implemented. During the operation, active cooperation with the surgical procedures and close observation of patient’s vital signs as well as adverse reactions such as nausea and vomiting were strictly carried out. After the treatment the management of PTCD drainage tube, the protection of radiation and the early detection of complications were further emphasized. Results The technical success rate of biliary stenting together with linear 125I seeds strand implantation was 100%. The serum total bilirubin levels, determined at one week, one and 3 months after the treatment, were significantly decreased when compared with the preoperative data. Clinically, the jaundice basically subsided. Bile-cardiac reflex occurred in one case and displacement of PTCD drainage tube in 2 cases. Twelve patients developed chills and fever after operation. Acute renal insufficiency occurred in one patient, which was relieved after effective management. The median survival time was 10.9 months. Conclusion Careful and comprehensive preoperative preparation can ensure a successful operation. Intraoperative close observation of patient’s condition and skilled cooperation with the operator, and high quality postoperative nursing measures and close observation for early signs of complications are essential nursing points to ensure that the patients can safely get over the rehabilitation period.