加贝酯在不同时期应用预防ERCP术后高淀粉酶血症及胰腺炎的临床研究

Clinical Study of Prophylactic Effect of Gabexate on Pancreatitis and Hyperamylasemia after ERCP during Different Periods

目的:观察加贝酯在不同时期应用对预防内镜逆行胰胆管造影(ERCP)术后高淀粉酶血症及胰腺炎的疗效。方法:将381例行ERCP术的胆胰疾病患者根据加贝酯的不同应用时期分为4组,分别为术前组88例、术后组97例、完全组101例及对照组95例。术前组、术后组及完全组均为用药组,术前组在ERCP术前6 h内予以加贝酯600 mg,溶于0.9%氯化钠注射液500 ml中静脉滴注;术后组在术后12 h内予以加贝酯600 mg,溶于0.9%氯化钠注射液500 ml中静脉滴注;完全组在ERCP术前6 h开始予以加贝酯600 mg,溶于0.9%氯化钠注射液500 ml中静脉滴注,并于术后12 h内再予以加贝酯600 mg,溶于0.9%氯化钠注射液500ml中静脉滴注;对照组用0.9%氯化钠注射液静脉滴注。ERCP术后24 h查血清淀粉酶并观察有无急性胰腺炎的临床表现。结果:各用药组术后24 h血清淀粉酶水平显著低于对照组(P<0.05);ERCP术前组、术后组、完全组及对照组术后高淀粉酶血症的发生率分别为28.41%、26.80%、15.84%、46.32%,急性胰腺炎的发生率分别为3.41%、3.09%、1.98%、9.47%,用药各组术后高淀粉酶血症及胰腺炎发生率均显著低于对照组(P<0.05);完全组术后24 h血清淀粉酶水平及高淀粉酶血症发生率均显著低于术前组、术后组(P<0.05),但3组间术后胰腺炎发生率差异无统计学意义。结论:加贝酯可有效地降低ERCP术后24 h血清淀粉酶水平,减少术后高淀粉酶血症及胰腺炎的发生率;推荐加贝酯的应用方式为:ERCP术前6 h 600 mg静脉滴注,术后12 h内600 mg静脉滴注。

OBJECTIVE： To observe the therapeutic efficacy of gabexate for pancreatitis and hyperamylasemia after ERCP dur- ing different periods. METHODS： According to different periods of gabexate, 381 patients underwent ERCP were divided into pre- operative group （88 cases）, postoperative group （97 cases）, complete group （101 cases） and control group （95 cases）. Preopera- tive group was given gabexate 600 mg dissolved in 0.9% Sodium chloride injection 500 ml intravenously 6 h before ERCP; postop- erative group was given same dose of drugs intravenously 12 h after ERCP; complete group was given same dose of drugs intrave- nously 6 h before ERCP and 12 h after ERCP; control group was given normal saline intravenously. Serum amylase was detected 24 h after ERCP, and clinical manifestations of acute pancreatitis were also observed. RESULTS： 24 h after ERCP, serum amylase of administration groups was significantly lower than that of control group （P〈0.05）. The incidence of hyperamylasemia in preoper- ative group, postoperative group, complete group and control group were 28.41%, 26.80%, 15.84% and 46.32%, the incidence of acute pancreatitis were 3.41%, 3.09%, 1.98% and 9.47%, respectively. The incidence of above 2 indicators in administration groups were significantly lower than in control group （P〈0.05）. The level of serum amylase and the incidence of hyperamylasemia in complete group were significantly lower than in preoperative group and postoperative group 24 h after operation （P〈0.05） ; the incidence of pancreatitis had no statistical significance among 3 groups after operation. CONCLUSIONS： Gabexate can effectively reduce serum amylase level and the incidence of pancreatitis and hyperamylasemia 24 h after ERCP. The best way to use gabexate is that intravenous infusion of gabexate 600 mg 6 h before ERCP and 12 h after ERCP.