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1、皖南醫(yī)學(xué)院學(xué)報(bào)(JofWannanMedicalCollege)2014;33(3·207··臨床醫(yī)學(xué)·文章編號(hào):1002—0217(2014)03—0207—05藥物預(yù)防ERCP術(shù)后急性胰腺炎的臨床對(duì)照研究劉少鋒,袁鶴嗚,陳藤千,楊培秀(皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院消化內(nèi)科,安徽蕪湖241001)【摘要】目的:對(duì)照研究使用不同藥物和不同時(shí)間點(diǎn)給藥時(shí),藥物對(duì)PEP的預(yù)防作用;分析PEP的危險(xiǎn)因素。方法:根據(jù)入選標(biāo)準(zhǔn),將ERCP患者分為三個(gè)低危組(Lk、)和四個(gè)高危組(H、H、HH),按照既定方案給予生長(zhǎng)抑素或加貝酯。觀察入組
2、病例的術(shù)前12h以?xún)?nèi)、術(shù)后3h、12h、24h的血淀粉酶和C反應(yīng)蛋白(后者術(shù)后3h不檢測(cè))。結(jié)果:低危組人選75例,并發(fā)高淀粉酶血癥7例(9.3%)、急性胰腺炎2例(2.7%);高危組入選295人,并發(fā)高淀粉酶血癥29例(9.8%)、急性胰腺炎14例(4.7%)。低危組之間高淀粉酶血癥和急性胰腺炎的發(fā)生率,以及術(shù)前、術(shù)后12h和術(shù)后24hCRP、血淀粉酶的比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。高危組之間高淀粉酶血癥發(fā)生率,以及術(shù)后12h血淀粉酶和術(shù)后24hCRP的總體比較,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),其中H組(
3、術(shù)前使用生長(zhǎng)抑素)的高淀粉酶血癥的發(fā)生率、術(shù)后12h血淀粉酶和術(shù)后24hCRP水平低于H和H組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);使用生長(zhǎng)抑素者(H+組)的胰腺炎和高淀粉酶血癥的發(fā)生率低于使用加貝酯者(H組)(P<0.05)。具有胰腺炎病史、乳頭多次插管和手術(shù)時(shí)間超過(guò)1h的高危組患者,其發(fā)生胰腺炎和高淀粉酶血癥的可能性較高。結(jié)論:具有高危因素的患者,建議術(shù)前使用生長(zhǎng)抑素以減少胰腺炎或高淀粉酶血癥的發(fā)生,效果優(yōu)于加貝酯;無(wú)高危因素的患者不建議預(yù)防性用藥?;颊叩囊饶懝懿∈?、乳頭插管次數(shù)和手術(shù)時(shí)間是PEP的主要危險(xiǎn)因素。【關(guān)鍵
4、詞】生長(zhǎng)抑素;加貝酯;經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)后急性胰腺炎;高淀粉酶血癥【中圖號(hào)】R576【文獻(xiàn)標(biāo)識(shí)碼】A【DOI】10.3969/j.issn.1002-0217.2014.03.007Preventiveeffectofdrugsonpost-ERCPacutepancreatitis:RandomizedcontrolledclinicaltrialLIUShaofeng,YUANHeming,CHENTengqian,YANGPeixiuDepartmentofGastroenterology,YijishanHo
5、spital,WannanMedicalCollege,Wuhu241001,China【Abstract】Objective:Toevaluatetheeffectivenessofthedifferentdrugsadministeredatdifferenttimeforpreventionofpost—endoscopicretrogradecholan-giopancreatography(ERCP)pancreatitis(PEP),andanalyzetherelatedriskfactorsassocia
6、tedwithPEP.Methods:Thetotalpatientswereallocatedtothreegroupsoflowerrisks(Ls1,Ls2,L0)andfourgroupsofhigherrisks(Hs1,Hs2,H1,H)onpreviouslydefinedinclusioncriteria,andmanagedwitheithersomatostatinorgabexateasprotoco1.Thesenlmamylaseandc—reactiveprotein(CRP)levelswe
7、redeterminedwithinthe12hbeforeERCPandat3,12and24hafterERCP,respectively(CRPmeasurementwasfree3hafteroperation).Results:Ofthe75patientsincludedinthelowerriskgroups.corn—plicatedhyperamylasemiawasseenin7(9.3%)andPEPin2(2.7%),andin295highriskpatients,heperamylasemia
8、occurredin29(9.8%)andPEPin14(4.7%).ThedifferencewasnotsignificantinthetwogroupsregardingPEPandhyperamyJasemiaaswellasCRPbeforeoperationandat12hand24hafteropera