双氯芬酸钠栓剂预防ERCP术后胰腺炎及高淀粉酶血症的临床研究

Diclofenac sodium suppository for prevention of post-ERCP pancreatitis and hyperamylasemia

目的探讨双氯芬酸钠栓剂对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240例患者按随机数字表法分为双氯芬酸钠组、生长抑素组和安慰剂常规治疗组,每组80例,观察其术前、术后4、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。结果 3组患者ERCP术前血清淀粉酶均为正常值。双氯芬酸钠组及生长抑素组术后4、24h血清淀粉酶水平,均明显低于常规治疗组,差异均有统计学意义(均P<0.01);双氯芬酸钠组术后4h血清淀粉酶水平低于生长抑素组(P<0.01),但术后24h两组差异无统计学意义(P>0.05)。ERCP术后高淀粉酶血症发生率,双氯芬酸钠组及生长抑素组均明显低于常规治疗组,差异均有统计学意义(P<0.05或0.01),但双氯芬酸钠组与生长抑素组之间差异无统计学意义(P>0.05)。双氯芬酸钠组及生长抑素组ERCP术后胰腺炎发生率均明显低于常规治疗组,差异均有统计学意义(P<0.05或0.01),但双氯芬酸钠组与生长抑素组之间,差异无统计学意义(P>0.05)。结论应用双氯芬酸钠栓可有效降低ERCP术后胰腺炎及高淀粉酶血症的发生率;双氯芬酸钠与生长抑素均能有效预防ERCP术后胰腺炎及高淀粉酶血症的发生,且双氯芬酸钠比生长抑素在应用便利性及经济上更有优势。

Objective To investigate the preventive effect of diclofenac sodium suppository for post- ERCP pancreatitis and hyperamylasemia. Methods A total of 240 patients undergoing endoscopic retrograde cholangiopancreatography （ERCP） were randomly assigned to receive diclofenac sodium suppository （n=80）, intravenous somatostatin （n=80）, or no special medi-cation （n=80）. The levels of serum amylase before ERCP and 4h, 24h after ERCP were measured, and the rate of acute pancre-atitis and hyperamylasemia after ERCP were assessed. Results Serum amylase levels before ERCP of three groups were al normal. The mean serum amylase levels in diclofenac group at 4h after ERCP were significantly lower than those in somatostatin and control groups （102.47 ±56.24U/L, 132.53 ±60.45U/L, 195.64 ±58.62U/L, respectively, both P0.05）. The incidence of hyperamylasemia after ERCP in diclofenac group（6.25%） and somatostatin group （7.50%） was significantly lower than that of control group （18.75%, P0.05）. The incidence of post- ERCP pancreatitis in diclofenac group（2.50%） and so-matostatin group （3.75%） were significantly lower than that of control group （12.50%, P0.05）. Conclusion Diclofenac sodium suppository and somatostatin can effectively reduce the incidence of acute pancreatitis and hyperamylasemia after ERCP, and the former is more cheep and con-venient.