双氯芬酸钠直肠给药预防经内镜逆行胰胆管造影术后胰腺炎的疗效观察

Observation on Efficacy of Rectal Administration of Diclofenac Sodium in Prevention of Pancreatitis After Endoscopic Retrograde Cholangio Pancreatography

目的:探讨双氯芬酸钠直肠给药对预防经内镜逆行胰胆管造影术后胰腺炎的疗效。方法:选取2016年1月—2016年12月复旦大学附属金山医院收治的拟行经内镜逆行胰胆管造影术患者180例作为研究对象,以随机数字表法分为口服低剂量组、口服高剂量组、直肠低剂量组、直肠高剂量组、口服安慰剂组及直肠安慰剂组,每组30例。六组患者于术前1 h分别口服双氯芬酸钠肠溶片50 mg,口服双氯芬酸钠肠溶片100 mg,直肠给予双氯芬酸钠栓50 mg,直肠给予双氯芬酸钠栓100 mg,口服安慰剂50 mg,直肠给予安慰剂100 mg。观察六组患者血清淀粉酶水平、Ranson评分、胰腺炎及高淀粉酶血症发生情况。结果:术后4、24及48 h,六组患者血清淀粉酶水平明显高于术前,且口服低剂量组、口服高剂量组、直肠低剂量组和直肠高剂量组患者明显低于口服安慰剂组、直肠安慰剂组,差异均有统计学意义(P<0.05);与口服安慰剂组、直肠安慰剂组比较,直肠低剂量组、直肠高剂量组患者胰腺炎发生率明显降低,直肠高剂量组患者高淀粉酶血症发生率明显降低,差异均有统计学意义(P<0.05);直肠高剂量组患者Ranson评分明显低于其他五组,差异均有统计学意义(P<0.05)。结论:高剂量双氯芬酸钠(100 mg)直肠给药预防胰腺炎的疗效较好,能明显减轻术后胰腺炎的严重程度。

OBJECTIVE： To probe into the efficacy of rectal administration of diclofenac sodium in prevention of pancreatitis after endoscopic retrograde cholangio pancreatography. METHODS： 180 patients undergoing endoscopic retrograde cholangio pancreatography admitted into Jinshan Hospital Affiliated to Fudan University from Jan. 2016 to Dec. 2016 were extracted and divided into oral low-dose group,oral high-dose group,rectal low-dose group,rectal high-dose group,oral placebo group and rectal placebo group via random number table,with 30 cases in each. At 1 h before operation,the six groups were respectively given 50 mg of diclofenac sodium enteric-coated tablets orally,100 mg of diclofenac sodium enteric-coated tablets orally,50 mg of diclofenac sodium suppositories in rectal,100 mg of diclofenac sodium suppositories in rectal,50 mg of placebo orally and 100 mg of placebo in rectal. The serum amylase levels, Ranson scores, incidences of pancreatitis and hyperamylasemia of six groups were observed.RESULTS： At 4 h,24 h and 48 h after operation,the serum amylase levels of six groups were significantly higher than those of before operation,the serum amylase levels of oral low-dose group,oral high-dose group,rectal low-dose group and rectal high-dose group were significantly lower than those of oral placebo group and rectal placebo group,with statistically significant differences（ P〈0. 05）; compared with oral placebo group and rectal placebo group,the incidences of pancreatitis of rectal low-dose group and rectal high-dose group had been significantly decreased,and theincidence of hyperamylasemia of rectal high-dose groups had been significantly decreased,with statistically significant differences（ P〈0. 05）; the Ranson score of rectal high-dose group was significantly lower than that of other five groups,with statistically significant difference（ P〈0. 05）. CONCLUSIONS： The efficacy of high-dose of diclofenac sodium（ 100 mg） in rectal administration in prevention of pancreatitis is remarkable,which can significantly relieve the severity of pancreatitis after operation.