关键词: 内镜下鼻胆管引流术, 无X线监视, 急性重症胆管炎, 感染性休克

Abstract: Objective Investigate the safety,feasibility and efficacy of emergency bedside endoscopic nasobiliary drainage(ENBD) in supine position without fluoroscopy in ICU for patients with severe acute cholangitis and septic shock. Methods In total,31 patients with severe acute cholangitis underwent emergency bedside ENBD in supine position without fluoroscopy in ICU from January 2012 to June 2018.The clinical datas were reviewed and analyzed. Results Endoscopic nasobiliary drainage was successful in all 31 patients,the operation success rate was 100%,the operation time was 27.23 minutes.High fever,inflamation and jaundice were quickly degraded,and heart rate and blood pressure regained steady soon after ENBD.There were 27,2 and 1 cases of patients with high fever(T≥39℃) on three different time points(before,1day and 2 days after ENBD),respectively.The proportions were respectively 87.1%,6.5% and 3.2%（P<0.05）.There were respectively 31,8 and 3 cases of patients with the fastest heart rate more than 100 beats per min on three different time points.The proportions were respectively 100%,25.8% and 9.7%（P<0.05）.There were respectively 31,10 and 2 cases of patients with hypotension requiring vasopressors of any dose on three different time points.The proportions were respectively 100%,32.3% and 6.5%（P<0.05）.There were respectively 28,12 and 4 cases of patients with WBC count more than 20×10^9/L on three different time points.The proportions were respectively 90.3%,35.5% and 12.9%（P<0.05）.There were respectively 29,12 and 7 cases of patients with total bilirubin(TB) level more than 100 μmol/L on three different time points(before,3 days and 5days after ENBD).The proportions were respectively 93.5%,38.7% and 22.6%.The proportions on 3days and 5days after ENBD compared with that before ENBD were declined significantly（P<0.05）.Twenty-nine patients were cured.Two patients were dead,Mortality rate was 6.5%.There was no ENBD-related complications. Conclusions Emergency bedside ENBD in supine position without fluoroscopy in ICU was safe and feasible.Without heavy X-ray machine,transporting patients,changing their position and through normal tract it possessed the least interference and trauma to patients and was a prompt and effective method of biliary drainage.

Key words: endoscopic nasobiliary drainage, no X-ray monitoringsevere acute cholangitis, septic shock