ERCP术中经十二指肠镜注入硫酸镁对胆总管结石患者血清淀粉酶水平的影响

Effect of Magnesium Sulfate Injection under Duodenoscope on Pancreatitis and Serum Amylase Level in ERCP

【目的】研究内镜下逆行胰胆管造影术（ERCP）中经十二指肠镜注入硫酸镁对血淀粉酶水平的影响及患者胰腺炎发生情况。【方法]2014年5月至2016年5月本院收治的82例拟行ERCP患者为研究对象，将其按随机数表法分为硫酸镁组与常规组，每组各41例。两组患者均给予ERCP、内镜十二指肠乳头括约肌切开术、内镜取石治疗，硫酸镁组在插管前向十二指肠乳头局部喷洒硫酸镁，比较两组血淀粉酶、C反应蛋白（CRP）、Oddi括约肌（SphincterofOddis，SO）压力、插管成功率及并发症发生情况。【结果】两组术后6h、24h血清血淀粉酶、CRP水平均显著高于术前，差并具有统计学意义（均P〈0．05）；硫酸镁组术后6h、24h血淀粉酶、CRP水平显著低于常规组（均P〈0．05）。两组喷洒10min后SO基础压力、SO收缩幅度、SO收缩频率较喷洒前显著提高（P〈0．05）。硫酸镁组喷洒10min后sO收缩间期与常规组比较差异无统计学意义（P〉0．05），SO基础压力、SO收缩幅度、SO收缩频率显著低于常规组（P〈0．05）。硫酸镁组插管成功率显著高于常规组，胰腺炎、高淀粉酶血症发生率显著低于常规组，差异具有统计学意义（P〈0．05）。【结论IERCP术中经十二指肠镜注入硫酸镁可松弛Oddi括约肌，有助于提高插管成功率，减轻胰腺组织损伤，降低血淀粉酶水平及胰腺炎发生率。

[Objective]To investigate the effect of Magnesium Sulfate injection by duodenal scope on serum amylase level and the occurrence of pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography（ERCP）.[Methods]A total of 82 patients undergoing ERCP in our hospital from May 2014 to May 2016 were enrolled in the study. Patients were ran- domly divided into magnesium sulfate group and routine group by random number table method, 41 cases in each group. All patients were treated by ERCP, endoscopic sphincteropapillotomy and endoscopic stone removal. Before intubation, magnesium sulfate was sprayed locally on duodenal papilla in magnesium sulfate group. Sernm amylase, C reactive protein （CRP）, Oddi sphincter pressure, success rate of intubation and incidence of complications were compared between the two groups. [Results] The serum amylase and CRP levels of the two groups after 6 h and 24 h were significantly higher than those before the opera- tion, and the difference was statistically significant （ P 〈0.05） ; The levels of serum amylase and CRP in the Magnesium Sul- fate group after 6 h and 24 h were significantly lower than those in the conventional group （ P 〈0.05）. 10 min after spraying, the SO basal pressure, SO contraction amplitude and SO contraction frequency of the two groups were significantly higher than those before spraying （ P 〈0.05）. There was no significant difference in SO interval between the Magnesium Sulfate group and the normal group after 10 rain spraying （ P 〉0.05） ; The SO basal pressure, SO contraction amplitude and SO contraction fre- quency were significantly lower than those in the conventional group （ P 〈0.05）. The successful rate of intubation in Magnesi- um Sulfate group was significantly higher than that in routine group, the incidence of pancreatitis and amylase was significantly lower than that of the routine group, the difference was statistically significant （ P 〈0.05）.[Conclusion] In ERCP surgery, Magnesium Sulfate injection can relax the sphincter of Oddi by endoscopy ,which can improve the success rate of intubation, reduce the damage of pancreatic tissue, reduce the level of serum amylase and the incidence of pancreatitis.