吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎使用时机探讨

Applied occasion of indomethacin on preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

目的探讨吲哚美辛预防经内镜逆行胰胆管造影术（ERCP）后胰腺炎的最佳使用时机。方法采用随机对照法，将纳入患者分为术前组和术后组，分别在ERCP术前30min、术后30min内予吲哚美辛100mg直肠内给药。测定患者术前、术后4h、术后24h血清淀粉酶、脂肪酶水平，评估术后急性胰腺炎、高淀粉酶血症、消化道出血、穿孔等并发症发生情况。结果2014年6月至2017年6月间共人组患者340例。其中术前组163例，发生急性胰腺炎11例（6．75％），高淀粉酶血症32例（19．63％）；术后组177例，发生急性胰腺炎25例（14．12％），高淀粉酶血症55例（31．07％）。术前组急性胰腺炎、高淀粉酶血症发生率较术后组低（P=0．027，P=0．016）。结论术前使用吲哚美辛较术后使用可以更好地减少ERCP术后胰腺炎的发生，并且不增加其他并发症的发生率。

Objective To investigate the optimal timing of indomethacin administration on prevention of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis. Methods The patients were randomly divided into the preoperative group and the postoperative group, and given 100 mg indomethacin in rectum within 30 min before and after ERCP, respectively. The serum levels of amylase and lipase were measured preoperatively and 4 h, 24 h postoperatively. The incidences of postoperative complications such as acute pancreatitis, hyperamylasemia, gastrointestinal bleeding, and perforation were assessed. Results A total of 340 patients were enrolled in this study from June 2014 to June 2017. The preoperative group consisted of 163 patients, including 11 cases （6. 75%） with post-ERCP pancreatitis （PEP） and 32 cases （19. 63%） with hyperamylasemia. Meanwhile, 177 patients constituted the postoperative group, with 25 cases （14. 12% ） with PEP and 55 cases （31.07%） with hyperamylasemia. The incidences of PEP and hyperamylasemia were significantly lower in the preoperative group than that in the postoperative group （P = 0. 027 and P = 0. 016, respectively）. Conclusion Preoperative use of indomethacin can better reduce the incidence of PEP than postoperative administration, without incidence increase of other complications.