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急性重症胰腺炎（ＳＡＰ）术后双套管引流的护理摘要】目的探讨急性重症胰腺炎术后应用双套管引流对改善预后和减少并发症的作用。
方法对２０例急性重症胰腺炎患者施行双套管引流的护理。
结果应用双套管引流对减少腹膜炎，胰腺周围脓肿等术后并发症及预后有积极效果。
结论急性重症胰腺炎术后做好双套管引流对改善其预后和减少其并发症的发生有重要的作用。
【关键词】急性重症胰腺炎；双套管引流；护理急性重症胰腺炎（简称ＳＡＰ）是当前一种常见的且极为凶险的外科危重急腹症之一。
起病迅速，并发症多，病死率高。
占急性胰腺炎的１０％－－－１５％。
由于出血和坏死组织脱落常需于术后放置双套管以保持胰腺周围引流管的通畅、有效。
护士应掌握双套管放置部位及作用，保持管道的有效引流是治疗重症胰腺炎的重点之一。
１．临床资料１．１一般资料本组病例２０例，男１３例，女７例，年龄３３～６０岁，腹腔穿刺均为血性液体，穿刺液淀粉酶测定均＞１０００Ｕ。
均有程度不同的休克。
其中，胆源性胰腺炎９例，暴饮暴食引起８例，高脂血症引起１例，腹膜炎引起１例，外伤１例。
术前均做ＣＴ及相关检查确诊。
最短导管留置时间３２天，最长留置时间６８天。
２０例中１８例治愈，１例出现肠瘘后放弃治疗，１例死亡。
本组病例无护理并发症发生。
１．２双套管的结构及引流原理腹腔双套管由一根外套管和一根内套管组成，外套管前端的管壁有６－７个侧孔，侧孔直径０．３－０．５ｃｍ。
外套管连接冲洗液，内套管末端接负压吸引器。
其引流原理是在具有低负压吸引的内管之外，套一个多孔的外管，内外管之间有一定的间隙。
外套管起支撑作用，前端封闭，避免肠壁或组织被负压吸引而损伤或堵塞管道，周围的多个侧孔有利于扩大吸引范围，使双套管周围产生全方位的负压，促进窦道的形成。
当胰腺周围有液体及坏死组织时，坏死物质将从外套管的多孔中进入内套管间隙，再由内套管低负压吸引，将坏死组织和引流液吸出。
内外套管均采用硅胶管，硅胶管较橡胶管硬，不易被负压吸引塌陷，异物反应小。
重症急性胰腺炎早期实施坏死胰腺清除及腹腔镜置管引流的手术技巧和临床疗效张炎祥;陈小伍;朱达坚;剧永乐;陆光生;耿岩;周围【摘要】目的：探讨重症急性胰腺炎（SAP）早期腹腔镜置管引流的手术技巧和临床疗效。
方法回顾性分析我院2007年1月至2014年12月期间早期进行腹腔镜手术置管引流的54例SAP病人的临床资料，全部病例均应用腹腔镜微创技术行胃结肠韧带切开，胰腺被膜切开减压，清除胰周积液及坏死组织，并置多管持续灌洗引流。
结果1例因术中出血中转开腹手术，1例因小肠损伤开腹小切口修补。
置管引流的手术时间102～185 min，平均128 min，治愈50例；住院时间17～106 d，中位时间31．5 d。
4例死亡，1例死于多器官功能衰竭，1例死于合并胰腺癌，2例死于迟发腹腔出血并失血性休克，死亡时间分别为术后4 d、21 d、33 d、36 d，1例术后32 d因胰周脓肿再次行腹腔镜手术，3例胰腺假性囊肿，1例保守治疗治愈，2例经穿刺引流后治愈。
结论早期采用腹腔镜置管引流手术治疗SAP，可有效地改善SAP的愈后，是一种有效的治疗方法。
%Objective To investigate the techniques and clinical efficacy in severe acute pancreatitis(SAP) catheter drainage by laparoscopic surgery. Methods The clinical data of 54 patients with SAP,.who were admitted to the First People’s Hospital of Shunde and underwent the early laparoscopic surgery catheter drainage from January 2007 to December 2014 ,.were retrospectively analyzed. Results Of the 54 cases, one case was converted to open surgery because of bleeding, one case was underwent the abdominal incision repair because of intestinal damage. The operation time ranged from 102 to 185 min and the average was 128 min..Fifty caseswere cured,.and the hospitalization time was 17-106 days (the median time was 30.5 days)..Four cases were died, in whom one case died of multiple organ failure , one case died of pancreatic cancer and two cases died of delayed abdominal bleeding and hemorrhagic shock. The time of death were 4 days , 21 days, 33 days and 36 days, respectively. One case underwent the second laparoscopic surgery in 32 days after the first operation because of pancreatic abscess..Three cases became to pancreatic pseudocyst..One case was cured with conservative treatment..Two cases were cured after puncture and drainage. Conclusion Early laparoscopic surgery catheter drainage can effectively improve the prognosis of SAP,.and becomes an effective method of treatment.【期刊名称】《岭南现代临床外科》【年(卷),期】2016(016)005【总页数】4页(P539-542)【关键词】重症急性胰腺炎;腹腔镜;手术技巧【作者】张炎祥;陈小伍;朱达坚;剧永乐;陆光生;耿岩;周围【作者单位】528300 广东佛山南方医科大学附属顺德第一人民医院普通外科;528300 广东佛山南方医科大学附属顺德第一人民医院普通外科;528300 广东佛山南方医科大学附属顺德第一人民医院普通外科;528300 广东佛山南方医科大学附属顺德第一人民医院普通外科;528300 广东佛山南方医科大学附属顺德第一人民医院普通外科;528300 广东佛山南方医科大学附属顺德第一人民医院普通外科;528300 广东佛山南方医科大学附属顺德第一人民医院普通外科【正文语种】中文【中图分类】R657.5+1重症急性胰腺炎（severe acute pancreatitis，SAP）是一种起病急骤，病理过程复杂，病情凶险多变，并发症及死亡率较高的急腹症，病死率高达10%～30%［1］。
重症急性胰腺炎各期经皮穿刺置管引流疗效贺炜;耿小平;黄帆;谢坤;陈江明;孙昀【摘要】目的探讨重症急性胰腺炎经皮穿刺置管引流治疗的时机及临床价值.方法回顾性分析采用经皮穿刺(置管)引流术治疗的125例重症急性胰腺炎病例资料.所有患者在CT及床边B超引导下行经皮穿刺引流术.结果首次穿刺引流时间距发病1~46(11.0±7.9)d,每例置管次数0~11次,平均3.2次,留置引流管时间0~128(27.1±16.6)d.共107例(107/125,85.6%)患者接受经皮穿刺(置管)引流或后期中转开腹手术治疗后康复,18例(18/125,14.4%)死亡.21例(21/117,17.9%)在行经皮穿刺置管引流后3~32(19.8±9.0) d接受开放手术治疗、16例(16/21,76.2%)最终获得治愈、5例(5/21,23.8%)死亡.穿刺置管引流总体有效率为70.9%(83/117),1周内为79.4%(27/34),1~2周为75.9%(22/29),2~4周为63.2%(24/38),4周后为62.5%(10/16);各阶段置管并发症发生例数分别为5、8、7、4(P=0.595);各阶段死亡例数为5(14.7%)、4(13.7%)、7(18.4%)、2(12.5%)(P=0.932).结论在遵循指南的基础上,观察患者的临床表现、置管引流有效性等更为重要;早期穿刺置管引流的最终有效率较高,安全、不增加感染率,但差异无统计学意义;后期不排斥中转开放手术治疗,但指征需进一步探究.%Objective To explore the timing and clinical value of percutaneous catheter drainage in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 125 consecutive patients with SAP treated with percutaneous puncture (catheter) drainage between January 2008 to October 2015 in the First Affiliated Hospital and Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed(81 cases in the First Affiliated Hospital,44 cases in the Second Affiliated Hospital).All percutaneouspuncture and drainage were guided by CT or bedside ultrasound.Results The time between the first percutaneous catheter drainage and the disease onset was 1~46(11.0±7.9) days, number of catheter per patient from 0 to 11, an average of 3.2.Indwelling dra inage tube time was 0~128(27.1±16.6) days.A total of 107 cases (107/125,85.6%) of patients were rehabilitated after percutaneous (catheter) drainage or late conversion to open surgical treatment, 18 cases(18/125,14.4%) died;21 cases (21/117,17.9%) received open percutaneous necrosectomy after percutaneous catheter drainage3~32 (19.8±9.0) days,16 cases(16/21,76.2%) obtained cured finally, 5 cases (5/21,23.8%) died.The overall efficiency rate of percutaneous catheter drainage was 70.9% (83/117), the efficiency rate of percutaneous catheter drainage within one week after onset was 79.4% (27/34), 1~2 weeks was 75.9% (22/29), 2~4 weeks was 63.2% (24/38), and after 4 weeks was 62.5% (10/16).The number of cases with complications of phases of percutaneous catheter drainage as follows: 5 cases, 8 cases, 7 cases, 4 cases(P=0.595).Number of deaths for phases of percutaneous catheter drainage was 5 cases (14.7%), 4 cases (13.7%), 7 cases (18.4%), 2 cases (12.5%)(P=0.932).Conclusion On the basis of following guidelines, the clinical manifestations of patients and effectiveness of drainage is more important in the choice of timing.Early drainage has more efficiency for ultimately efficacy.It is safe and does not increase infection rate,but the difference is not statistically significant.The treatment does not exclude the open surgery in the later period, but indications of conversion need to be explored further.【期刊名称】《安徽医科大学学报》【年(卷),期】2017(052)003【总页数】5页(P421-425)【关键词】重症急性胰腺炎;经皮穿刺置管引流;时机【作者】贺炜;耿小平;黄帆;谢坤;陈江明;孙昀【作者单位】安徽医科大学第二附属医院普外科,合肥 230601;安徽医科大学第二附属医院普外科,合肥 230601;安徽医科大学第二附属医院重症医学科,合肥230601;安徽医科大学第一附属医院肝胆胰外科,合肥 230022;安徽医科大学第一附属医院肝胆胰外科,合肥 230022;安徽医科大学第二附属医院普外科,合肥230601;安徽医科大学第二附属医院重症医学科,合肥 230601【正文语种】中文【中图分类】R657.5+1重症急性胰腺炎(severe acute pancreatitis，SAP)是常见高死亡率的危重疾病。
