ESD术中并发症的护理预警与干预策略：聚焦出血、穿孔与电凝综合征

Nursing Early-Warning and Intervention Strategies for Intraoperative Complications of Endoscopic Submucosal Dissection: Focus on Bleeding, Perforation, and Post-ESD Coagulation Syndrome

摘要: 内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)已成为早期消化道肿瘤及癌前病变微创治疗的重要手段，具有整块切除率高、病理评估完整等优势，但其操作复杂、技术要求高，术中及围术期并发症仍是影响患者安全和治疗质量的关键问题。其中，出血、穿孔和电凝综合征是ESD最常见且最具临床意义的并发症。本文围绕ESD术中及围术期并发症的护理预警与干预策略进行综述，重点分析出血、穿孔和电凝综合征的发生机制、危险因素、早期识别指标及循证护理干预措施。现有研究显示，病变部位、病灶大小、黏膜下纤维化程度、抗栓药物使用、操作者经验及能量模式选择等均与并发症发生密切相关。构建基于术前风险分层、术中动态监测、术后标准化观察和快速反应团队联动的多维度护理预警体系，有助于实现并发症的早发现、早干预和早处理。未来需进一步开展高质量随机对照研究，完善护理干预证据，推动人工智能辅助预警、智能监测设备及多学科协作模式在ESD安全管理中的应用，以提升患者围术期安全性和护理质量。

Abstract: Endoscopic submucosal dissection (ESD) has become an important minimally invasive technique for the treatment of early gastrointestinal tumors and precancerous lesions, owing to its high en bloc resection rate and ability to provide complete pathological assessment. However, because of its technical complexity and demanding procedural requirements, intraoperative and perioperative complications remain major concerns affecting patient safety and treatment quality. Among these complications, bleeding, perforation, and post-ESD coagulation syndrome are the most common and clinically significant. This review summarizes nursing early-warning and intervention strategies for ESD-related complications, with a particular focus on the mechanisms, risk factors, early recognition indicators, and evidence-based nursing interventions for bleeding, perforation, and post-ESD coagulation syndrome. Current evidence suggests that lesion location, lesion size, degree of submucosal fibrosis, use of antithrombotic agents, operator experience, and selection of electrosurgical energy mode are closely associated with the occurrence of complications. Establishing a multidimensional nursing early-warning system based on preoperative risk stratification, intraoperative dynamic monitoring, standardized postoperative observation, and rapid response team collaboration may facilitate early detection, timely intervention, and effective management of complications. Future studies should include high-quality randomized controlled trials to strengthen the evidence base for nursing interventions and promote the integration of artificial intelligence-assisted warning systems, intelligent monitoring devices, and multidisciplinary collaboration into ESD safety management, thereby improving perioperative patient safety and nursing quality.