帕瑞昔布钠预防内镜下逆行胰胆管造影术后胰腺炎和高淀粉酶血症的临床研究

Prevention of post-ERCP pancreatitis and hyperamylasemia with pancreatitis

目的探讨帕瑞昔布钠对内镜下逆行胰胆管造影(ERCP)术后胰腺炎及高淀粉酶血症的预防作用。方法将280名拟行ERCP且术前血清淀粉酶正常的患者,随机分为预防组(140例)及对照组(140例)。预防组在ERCP术前30min肌肉注射地西泮及山莨菪碱各10mg,同时静脉注射帕瑞昔布钠40mg;对照组在ERCP术前30min肌肉注射地西泮及山莨菪碱各10mg。分别于ERCP术后6及24h检测血清淀粉酶水平并观察有无急性胰腺炎的临床表现。结果 ERCP术后预防组6和24h血清淀粉酶的水平均低于对照组,差异均具有显著性(P<0.05)。术后急性胰腺炎的总发生率为7.1%,其中预防组和对照组急性胰腺炎的发生率分别为3.6%、10.6%,术后6及24h高淀粉酶血症的发生率分别为16.4%、29.3%和11.4%、20.7%,预防组高淀粉酶血症和急性胰腺炎的发生率均低于对照组,差异均具有显著性(P<0.05)。结论帕瑞昔布钠可以有效地预防ERCP术后胰腺炎及高淀粉酶血症的发生。

【Objective】To determine the preventive effects of parecoxib sodium on pancreatitis and hyperamylasemia after ERCP （endoscopic retrograde cholangiopancreatography）.【Methods】Two hundred and eighty patients with scheduled ERCP and normal blood amylase pre-ERCP were enrolled. They were randomized into the preventive group （n=140） and control group （n=140）. In addition to routine diazepam （10 mg） and anisodamine （10 mg） given intramuscularly in both groups before ERCP, 40 mg of parecoxib sodium was infused intravenously 30 min before ERCP. Serum amylase level was measured 6 hours and 24 hours after the procedure. Clinical manifestations of acute pancreatitis were also observed. 【Results】The serum amylase level of preventive group at 6 and 24 h was lower than that of control group （P 0.05）. The incidence of hyperamylasemia was 16.4% in the preventive group and 29.3% in the control group at 6 h post-ERCP, and was 11.4% and 20.7% at 24 h post-ERCP. The overall incidence of acute pancreatitis was 7.1%, which included 3.6% in the preventive group and 10.6% in the control group, indicating statistical significance between two groups （P 0.05）.【Conclusion】Parecoxib sodium can prevent hyperamylasemia and acute pancreatitis induced by ERCP.