鼻胆管引流联合甲硝唑灌注对预防逆行胰胆管造影术后高淀粉酶血症和胰腺炎的临床研究

Clinical study on EBND combined with mezendazole infusion on the prevention of post-ERCP pancreatitis and post-ERCP hyperamlyasemia

目的探讨鼻胆管引流(EBND)联合甲硝唑灌注对逆行胰胆管造影(ERCP)术后高淀粉酶血症(PEPH)和ERCP术后胰腺炎(PEP)发生的预防作用。方法选择2013年8月~2016年8月期间在右江民族医学院附属医院经B超、MRI和磁共振胰胆管造影(MRCP)证实为胆总管结石并成功实施ERCP+十二指肠乳头括约肌切开术(EST)+取石术+EBND治疗的70例住院患者,按随机数字表分为两组,每组35例,实验组给予甲硝唑注射液100 ml灌注、冲洗,30 min/次,2次/d,连用5天;对照组给予0.9%氯化钠注射液100 ml灌注、冲洗,30 min/次,2次/d,连用5天。观察两组患者术前及术后2 h、12 h、24 h、48 h血淀粉酶水平的变化情况。结果术前两组血清淀粉酶比较差异无统计学意义(P>0.05);术后12 h、24 h、48 h两组血清淀粉酶均升高,差异均有统计学意义(P<0.01),且对照组术后12 h、24 h、48 h血清淀粉酶含量明显高于实验组,差异均有统计学意义(P<0.001)。实验组与对照组PEPH发生率分别为14.29%、37.10%,实验组PEPH发生率明显低于对照组,差异有统计学意义(P<0.05)。实验组PEP发生率为2.86%,低于对照组的14.29%,但比较差异无统计学意义(P>0.05)。两组患者均未出现严重不良反应。结论EBND联合甲硝唑灌注能有效降低PEPH的发生,局部高浓度用药有利于提高疗效,方法简单易行,安全可靠,患者易于接受且耐受度高,值得临床推广和应用。

Objective To investigate the preventive effect of endoscopic naso-biliary drainage（ EBND） combined with metronidazole infusion on post-ERCP hyperamlyasemia（ PEPH） and post-ERCP pancreatitis（ PEP）.Methods 70 inpatients who were confirmed with choledocholithiasis by B-ultrasound,MRI and magnetic resonance cholangiopancreatography（ MRCP） and treated with ERCP ＋ endoscopic sphincterotomy（ EST） ＋ stone extraction ＋ EBND in Affiliated Hospital of Youjiang University for Nationalities from August 2013 to August 2016 were selected. They were divided into experimental group and control group according to random number table,with 35 cases in each group.The experimental group were perfused with metronidazole injection（ 100 ml） and rinsed for 30 min/twice a day for 5 days. The control group were perfused with 0. 9% sodium chloride injection（ 100 ml） and rinsed for 30 min/twice a day for 5 days.And then,the changes of serum amylase levels before operation and 2 h,12 h,24 h and 48 h after operation were observed in the two groups.Results There was no statistically significant difference in serum amylases between the two groups before operation（ P〉0.05）.12 h,24 h and 48 h after operation,however,the serum amylases increased in the two groups,and difference was statistically significant（ P〈0. 01）,and the serum amylase contents in the control group were significantly higher than those in the experimental group（ P〈0.001）.The incidence of PEPH in the experimental group and the control group was 14.29% and 37.10% respectively,and that in the experimental group was significantly lower than that in the control group,difference was statistically significant（ P〈0.05）.The incidence of PEP in the experimental group was 2.86%,which was lower than that in the control group（ 14.29%）,but difference was not statistically significant（ P〉0.05）. No serious adverse reactions were found in the two groups. Conclusion EBND combined with metronidazole perfusion can effectively reduce the occurrence of PEPH,local high concentration medication is conducive to enhance curative effect,and the method is simple,safe and reliable.Patients are easy to accept and have high tolerance,so it is worthy of clinical popularization and application.