直肠应用吲哚美辛联合舌下含服硝酸甘油预防ERCP术后胰腺炎

Clinical Study of Indometacin Combined with Nitroglycerin in Preventing Post-ERCP Pancreatitis

【目的】研究直肠应用吲哚美辛联合舌下含服硝酸甘油预防ERCP术后胰腺炎的临床疗效。【方法】将105例胆总管结石患者随机分为A、B、C 3组,每组35例,A组采用基础治疗;B组采用基础治疗+术前30 min给予吲哚美辛栓100mg塞肛;C组采用基础治疗+术前30 min给予吲哚美辛栓100 mg塞肛+舌下含化硝酸甘油0.5 mg。检测患者ERCP术前、术后6、24、48 h血清淀粉酶,比较3组患者血清淀粉酶变化情况、高淀粉酶血症及PEP发生率和术后临床症状体征评分变化情况。【结果】1A组术后6、24、48 h血清淀粉酶明显高于B、C组(P<0.05),术后24、48 h血清淀粉酶B组明显高于C组,差异有统计学意义(P<0.05)。2 3组患者ERCP术后高淀粉酶血症、PEP发生率比较,C组明显低于A、B组,差异有统计学意义(P<0.05)。3 3组患者术前、术后48 h临床症状、体征评分无显著性差异(P>0.05),术后24 h B、C组症状体征评分明显低于A组(P<0.05),而B、C组比较,无显著性差异,疗效相当。【结论】直肠应用吲哚美辛联合舌下含服硝酸甘油能够降低ERCP术后血清淀粉酶水平,减少高淀粉酶血症的发生,从而预防术后胰腺炎的发生。

[Objective ] To study the clinical study of indometacin combined with nitroglycerin in preventing post-ERCP pancreatitis. [Methods] 105patients of choledoeholithiasis were randomly divided into three groups. Each group had 35 cases. The basic treatmentare available for Group A. The basic treatment and giving indomethacin 100mg preoperative 30 minare available for Group B ; The basic treatment and giving indomethacin lOOmg and Nitroglycerin 0.5rag preoperative 30rain are available for Group C. To test serum amylaseat pre-ERCP, 6h, 24 hand 48 hourpost-ERCP. And to compare the changes of serum amylase, the incidence rate of hyperamylasemia and post-ERCP pancreatitis, changes of clinical symptoms and signs score. [ Results] ①Serum amylase of group A were significantly higher than group Band group C （P 〈 0.05）.At 24h and 48 hpost-ERCP, serum amylase in groupB was significantly higher than that in C group, the difference was statistically significant （P 〈 0.05）. ②Comparison of the incidence rate of hyperamylasemia and post-ERCP pancreatitis, group C was significantly lower than group A and B, there were significant differences between the three groups （P 〈 0.05）. ③The clinical symptoms and signs scores had no significant difference in the three groupspre- ERCP and 48h post-ERCP （P 〉 0.05）. Andat 24 hpost-ERCP, the score in group B and Cwas significantly lower in group A （P〈 0.05 ）, no significant difference between group B and C. [ Conclusions ] The method ofindometacin combined with nitroglycerin can reduce the serum amylase and the incidence rate of hyperamylasemia after ERCP, and it can prevent post-ERCP pancreatitis.