| 刘鹏飞,冯义朝,薛顺和,王玲.双氯芬酸钠和鼻胆管引流预防内镜逆行性胰胆管造影术后胰腺炎及高淀粉酶血症的效果[J].中国临床保健杂志,2017,20(6):707-709. |
| 双氯芬酸钠和鼻胆管引流预防内镜逆行性胰胆管造影术后胰腺炎及高淀粉酶血症的效果 |
| The prophylactic effect of diclofenac sodium suppository and endoscopic nasobiliary drainage for post-ERCP pancreatitis and hyperamylasemia |
| 投稿时间：2017-05-26 |
| DOI：10.3969/J.issn.1672-6790.2017.06.023 |
| 中文关键词: 胰胆管造影术,内镜逆行 手术后并发症 消炎药,非甾类 引流术 |
| 英文关键词: Cholangiopancreatography,endoscopic retrograde Postoperative complications Anti-Inflammatory agents,non-steroidal Drainage〖FL |
| 基金项目:陕西省延安市科研项目(2015HM-04-04) |
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| 中文摘要: |
| 目的 观察双氯芬酸钠栓剂及术后鼻胆管引流术(ENBD) 对内镜逆行性胰胆管造影术(ERCP)后胰腺炎和高淀粉酶血症的预防效果。方法 将行ERCP 手术的150例患者按随机数字表法分为双氯芬酸钠组、ENBD组和对照组,每组50例,ERCP术前15 min 分别给予3组患者肌注哌替啶50 mg、山莨菪碱10 mg及地西泮5 mg；选用35%优维显为造影剂,电子十二指肠镜选用OlympusTJF260 型。对照组:给予安慰剂栓纳肛,术后予抗炎、补液、抑酸等常规治疗；双氯芬酸钠组:在常规治疗的基础上,术前1 h及术后1 h予双氯芬酸钠栓剂(湖北人福成田药业有限公司)50 mg纳肛。ENBD 组:在常规治疗的基础上,术后予鼻胆管(日本 Olympus)引流管置入,并保持引流通畅,术后禁食至血淀粉酶正常且无腹痛。观察术前,术后 2、6、24 h血清淀粉酶水平,比较三组ERCP术后胰腺炎和高淀粉酶血症发生率。结果 术前3 组ERCP患者血清淀粉酶均正常。双氯芬酸钠组ERCP术后胰腺炎(PEP,6.0%)及高淀粉酶血症(4.0%)的发生率及ENBD 组PEP(4.0%)及高淀粉酶血症(8.0%)的发生率与安慰剂组比较,均低于安慰剂组(18.0%和14.0%)(均P＜0.05)。双氯芬酸钠组[术后2 h血清淀粉酶是(234.3±62.6) u/L,术后6 h检测值是(178.3±56.6)u/L]和 ENBD 组[术后2 h血清淀粉酶(227.9±76.8) u/L,术后6 h为(189.4±52.3)u/L]在术后 2、6 h 较安慰剂组[(345.7±76.1)u/L,(298.3±58.9)u/L]低(均P＜0.05)；但术后24 h 各组间血清淀粉酶水平比较差异无统计学意义(均P＞0.05) 。结论 双氯芬酸钠栓剂和ENBD可有效预防 ERCP 术后胰腺炎及高淀粉酶血症的发生。 |
| 英文摘要: |
| Objective To observe the prophylactic effect of diclofenac sodium suppository and Endoscopic Nasobiliary drainage on post-ERCP pancreatitis and hyperamylasemia.Methods 150 cases of patients undergoing ERCP surgery were randomly divided into receiving diclofenac sodium suppository (n=50), ENBD group (n=50)and no special medication (n=50),The levels of serum amylase before ERCP and 2 h,6 h,24 h after ERCP were measured,and the rate of acute pancreatitis and hyperamylasemia after ERCP were assessed among the three groups.Results Serum amylase levels before ERCP of three groups were all normal.The incidences of pancreatitis and amylase of diclofenac sodium suppository(6.0%,4.0%) and ENBD group(4.0%,8.0%)were significantly lower than those of control group (18.0% VS.14.0%,P＜0.05),The mean serum amylase levels in diclofenac group[the mean serum amylase levels is (234.3±62.6) u/L 2 hours after operation,(178.3±56.6) u/L 6 hours after operation] and ENBD group [the mean serum amylase levels is (227.9±76.8) u/L 2 hours after operation,(189.4±52.3) u/L 6 hours after operation] at 2 h,6 h after ERCP were significantly lower than those in control groups [(345.7±76.1) u/L,(298.3±58.9) u/L,both P＜0.05)].While there was no difference among diclofenac sodium suppository,ENBD group and no special medication (P＞0.05).Conclusion Diclofenac sodium suppository and somatostatin can effectively reduce the incidence of acute pancreatitis and hyperamylasemia after ERCP. |
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