Methods and skills of nursing coordination during endoscopic treatment for patients with esophageal and gastricfundus variceal hemorrhage caused by liver cirrhosis
肝硬化食道胃底静脉曲张破裂出血行内镜下止血的护理配合方法与技巧

摘要

目的 探讨由肝硬化导致的食道、胃底静脉曲张破裂出血患者内镜下治疗的护理配合方法与技巧。方法 回顾性分析2021年1月至12月期间，在海军军医大学第三附属医院内镜科收治了58例因肝硬化引起食道或胃底静脉曲张破损大出血的患者，其中28例采取内镜下多连环套扎术（EVL），16例则采取食管静脉曲张套扎结合胃底静脉组织胶注入疗法。11例胃底静脉曲张采用硬化剂+组织胶+硬化剂“三明治”夹心注射治疗，而3例患者则接受了食道胃底部静脉曲张精准断流术，以获得更好的治愈效果。结果 58例患者中55例获得了令人满意的止血治疗效果，其中94.8%(55/58)的病人取得了成功，然而3例患者在内镜下治疗后6小时内出现了再次出血，因此采取三腔气囊管压迫止血的方法。有42例经内镜治疗后3个月后来我院进行内镜复查，镜见食道曲张静脉基本消失及胃底静脉曲张注射部位有脱胶现象。结论 做好术前准备、术中配合和术后护理，出院后做好定期随访工作，可使内镜下治疗食道胃底静脉曲张破裂出血顺利进行，取得满意效果。本研究重点关注食道静脉曲张和胃底静脉曲张，并探讨内镜治疗的可行性和护理配合情况。

Abstract

Objective The objective of this paper is to investigate the techniques and abilities of nursing coordination during endoscopic care for those suffering from esophageal and gastric fundus variceal hemorrhage, caused by liver cirrhosis.
Methods From January to December of 2021, 58 individuals suffering from esophageal or gastric fundus variceal rupture and hemorrhage due to liver cirrhosis at Oriental Hepatobiliary Surgery Hospital affiliated with Naval Medical University were retrospectively studied. Among them, 28 cases with esophageal varices were treated with esophageal variceal ligation(EVL), and 16 cases underwent combination of esophageal variceal ligation(EV) and gastric fundus vein tissue glue injection.Eleven cases with gastric fundus varices were administered "sandwich" injection (EVB) containing sclerotic agent, tissue glue, and sclerotic agent, while three cases with esophageal and gastric bottom varices were treated with endoscopic selective devascularization (ESVD).
Results Among 58 cases, 55 cases were stanched effectively, and the success rate of hemostasis was 94.8%(55/58). 3 patients suffered rebleeding within 6 hours after endoscopic treatment, and were treated with three-cavity balloon tube compression for hemostasis. There were 42 cases of endoscopic reexamination in our hospital 3 months after endoscopic treatment, and it was found that esophageal varicose veins basically disappeared and the injection site of gastric fundus varicose veins degummy phenomenon.
Conclusion   It is useful that preoperative preparation, intraoperative cooperation, postoperative care and regular follow-up after discharge are well done, these factors can make the endoscopic treatment of esophageal and gastric variceal hemorrhage proceed smoothly and achieve satisfactory results. This study focuses on esophageal varices and gastric varices, the feasibility of endoscopic treatment and nursing cooperation were also discussed.