吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎和高淀粉酶血症的临床研究

Indomethacin for prevention of post-ERCP pancreatitis and hyperamylasemia

目的探讨吲哚美辛对ERCP术后胰腺炎和高淀粉酶血症的预防作用。方法将拟施行ERCP手术的600例患者随机表法分为吲哚美辛组、奥曲肽组和安慰剂对照组，每组200例，观察其术前、术后24h血清淀粉酶水平，并评估ERCP术后胰腺炎和高淀粉酶血症发生率及预后。结果3组患者ERCP术前血清淀粉酶均为正常值。ERCP术后24h血清淀粉酶水平，吲哚美辛组[（101．3±77．7）U／L]低于奥曲肽组[（176．6±138．3）U／L]及对照组[（227．2±264．9）U／L]，差异均有统计学意义（P=0．040，P=0．048）；奥曲肽组低于对照组，但差异没有显著意义（P〉0．05）。ERCP术后胰腺炎发生率，吲哚美辛组（2．5％）低于对照组（9．5％），差异有显著性意义（P=0．003）；奥曲肽组（4．5％）低于对照组，但无统计学差异（P=0．05）。ERCP术后高淀粉酶血症发生率，吲哚美辛组（5．5％）低于对照组（13．5％），差异有显著性意义（P=0．006）；奥曲肽组（10．0％）低于对照组，但差异没有统计学意义（P〉0．05）。结论ERCP术前应用吲哚美辛可有效降低胰腺炎和高淀粉酶血症的发生率。

Objective To investigate the preventive effect of Indomethacin for post-ERCP pancreatitis and hyperamylasemia. Methods A total of 600 patients, who were undergoing ERCP, were randomly divided into 3 groups to receive anal Indomethacin （ n = 200）, intravenous octreotide （ n = 200） or no special medication （ n = 200） before ERCP. The level of serum amylase before and 24h after ERCP were measured, and the rate of acute pancreatitis and hyperamylasemia after ERCP were assessed. Results Serum amylase levels before ERCP of all groups were normal. The mean serum amylase level of Indomethacin group （ 101.3 ± 77.7 U/L） after ERCP was significantly lower than those of octreotide group （ 176. 6 ± 138.3 U/L, P = 0. 040 ] and control group （227. 2 ± 264. 9 U/L, P = 0. 048 ）, while there was no difference between oc- treotide group and control group （ P 〉 0. 05 ）. The incidence of post-ERCP pancreatitis in Indomethacin group （2. 5% ） was significantly lower than that of control group （9. 5%, P =0. 003）, while there was no difference between octreotide group （9. 5 % ） and control group （ P = 0. 05 ）. The incidence of hyperamylasemia after ERCP in Indomethacin group （5. 5% ） was significantly lower than that of control group （13.5%, P =0. 006）, while there was no difference between octreotide group （10. 0% ） and control group （P 〉 0. 05）. Conclusion Anal administration of Indomethacin before ERCP can effectively reduce the incidence of acute pancreatitis and hyperamylasemia after ERCP.