吲哚美辛不同时段给药预防内镜逆行胰胆管造影取石术后胰腺炎的效果

Clinical effect of indomethacin administered at different time points on prevention of postERCP pancreatitis

目的探讨不同时间段给予吲哚美辛栓剂预防内镜逆行胰胆管造影取石术后胰腺炎的效果。方法选取2014年12月-2015年12月于我院消化内科拟行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)取石治疗的胆总管结石患者,随机分为吲哚美辛组(n=144)和对照组(n=144),吲哚美辛组患者进一步分为A组(n=36,术前2 h给药)、B组(n=36,术前30 min给药)、C组(n=36,术后30 min给药)、D组(n=36,术后2 h给药),对照组为E组。比较各组术后高淀粉酶血症及术后胰腺炎(post-ERCP pancreatitis,PEP)发生情况。结果各组间年龄、性别、术前血清淀粉酶水平差异无统计学意义(P>0.05)。术后吲哚美辛组胰腺炎发生率为9.0%,低于对照组的18.8%(P=0.017)。A组、B组、C组、D组的PEP发生率分别为13.9%、5.6%、8.3%、8.3%,各组间两两比较,差异无统计学意义(P>0.05);B组和C组的术后高淀粉酶血症发生率分别为11.1%、16.7%,明显低于A组和D组的38.9%、36.1%,差异有统计学意义(P<0.05)。结论不同时段给予吲哚美辛均可降低PEP的发生率;术前30 min或术后30 min给药更有助于降低术后高淀粉酶血症的发生率。

Objectives To evaluate the clinical effect of indomethacin administered at different time points on the prevention of post-ERCP pancreatitis. Methods Totally 288 patients with common bile duct stones who received ERCP in our hospital＇s gastroenterology department from December 2014 to December 2015 were selected in this study. They were randomly divided into indomethacin group（n=144） and control group（n=144）. Meanwhile the indomethacin group were further grouped into group A（n=36, administered 2 hours before the surgery）, group B（n=36, administered 30 minutes before the surgery）, group C（n=36, administered 30 minutes after the surgery） and group D（n=36, administered 2 hours after the surgery）. Group E was the control group. Then we compared the incidences of hyperamylasemia and PEP after operation between different groups. Results There was no significant difference in patients＇ age, sex, serum amylase level before operation between groups（P〉0.05）. The incidence of postoperative pancreatitis in indomethacin group was 9.0% which was significantly lower than that of the control group＇s 18.8%（P=0.017）. Meanwhile the occurrence rates of PEP in group A, group B, group C, group D were 13.9%, 5.6%, 8.3% and 8.3% respectively, and the difference was not statistically significant（P〉0.05）. But the occurrence rates of hyperamylasemia in group B and group C were significantly lower than those of group A and group D. Conclusion Treated with indomethacin at different points can all reduce the incidence of PEP; indomethacin administered at 30 minutes before the surgery or 30 minutes after the surgery will reduce the incidence of postoperative hyperamylasemia.