柴芍承气汤加丹参高位保留灌肠对ERCP术后胰腺炎及高淀粉酶血症的干预作用

Clinical efficacy of high retention enema with Chaishao Chengqi decoction modified with salvia miltiorrhiza in prevention of pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography

目的探讨柴芍承气汤加丹参高位保留灌肠对内镜逆行胰胆管造影术(endoscopic retrograde cholangio-pancreatography,ERCP)术后胰腺炎及高淀粉酶血症的干预作用.方法 83例患者随机分为治疗组(n=39)及对照组(n=44),对照组术后予禁食、补液、抑酸、抑制胰酶活性、使用抗生素等常规治疗,治疗组在对照组基础上,于ERCP术前6 h,术后1 h开始予柴芍承气汤加丹参高位保留灌肠,2次/d,观察两组术中胆管插管时间、手术时长、治疗前后血清淀粉酶(serum amylase,AMS)及超敏C反应蛋白(high-sensitivity C-reactive protein,Hs-CRP)的变化、腹痛的情况及程度、住院时间及住院费用、术后胰腺炎(post-ERCP pancreatitis,PEP)及术后高淀粉酶血症(post-ERCP hyperamylasemia,PEH)的发生情况,并进行统计学分析.结果治疗组发生1例PEP,对照组发生2例PEP,两组比较无统计学差异(P>0.05);治疗组和对照组相比,术后3 h的AMS、术后12 h、术后24 h的AMS和Hs-CRP、腹痛发生率及程度、术后PEH的发生率、住院时间及费用均优于对照组(P<0.05);两组术中胆管插管时间、手术时长、术后3 h Hs-CRP差异无统计学意义(P>0.05).结论柴芍承气汤加丹参高位保留灌肠能有效降低PEH发生率,降低AMS、Hs-CRP水平及腹痛的发生率。

AIM To investigate the efficacy of high retention enema with Chaishao Chengqi decoction modified with salvia miltiorrhiza in the prevention of pancreatitis and hyperamy- lasemia after endoscopic retrograde cholangio- pancreatography （ERCP）. METHODS Eighty-three patients who would undergo ERCP were randomly divided into a treatment group and a control group. Both groups were treated by fasting, rehydration, acid suppression, inhibition of pancreatic enzyme activity, use of antibiotics and other routine treatments. The treatment group was additionally treated with high retention enema by Chaishao Chengqi decoction modified with salvia miltiorrhiza 6 h beforeERCP and 1 h after ERCP, twice a day. Before and after treatment, amylase （AMS） and high-sensitivity C-reactive protein （Hs-CRP） were detected. Meanwhile, cannulation time, operative time, postoperative abdominal pain, hospital stays, and hospitalization cost were compared. RESULTS One patient in the treatment group and two patients in the control group developed post- ERCP pancreatitis （PEP）, and there was no significant difference in the rate of PEP between the two groups （P 〉 0.05）. AMS at 3 h, AMS and Hs-CRP at 12 h and 24 h, the rate and degree of abdominal pain, the rate of post- ERCP hyperamylasemia （PEH） and hospitalization cost were , hospital stays, all significantly better in the observation group than in the control group （P 〈 0.05）. There was no significant difference between the two groups in cannulation time, operative time or Hs-CRP at3 h. CONCLUSION High retention enema with Chaishao Chengqi decoction modified with salvia miltiorrhiza can effectively reduce the incidence of PEH, lower AMS and Hs-CRP, reduce the incidence of abdominal pain, shorten the length of hospital stay and reduce hospitalization costs, although it has no obvious effect on ERCP operative time and the incidence of PEP.