清胰利胆汤灌肠预防48例内镜逆行胰胆管造影术术后胰腺炎的临床研究

Clinical Study on Qingyi Lidan Mixture Enema in the Preventive of 48 Cases of Post ERCP Pancreatitis

目的观察清胰利胆汤灌肠对48例经内镜逆行胰胆管造影术后胰腺炎(post-ERCP pancreatitis,PEP)和高淀粉酶血症(post-ERCP hyperamylasemia,PEH)的预防作用,以及初步探究其对炎症介质白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、白细胞介素-10(interleukin-10,IL-10)的影响。方法选取该院2016年10月—2019年1月收治的96例预行ERCP术的患者,采用随机数字法分成中药组(48例)和对照组(48例)。两组术前均常规治疗,中药组术前2 h给予清胰利胆汤100 m L保留灌肠,对照组术前2 h给予吲哚美辛栓0.1 g塞肛。记录并比较两组术前、术后4 h、术后24 h的血清淀粉酶、IL-6、IL-8、IL-10情况;记录患者术后腹痛腹胀、排气等临床症状,并分别记录两组患者的发生情况。结果中药组与对照组的PEP和PEH发生率、术前术后血清淀粉酶、IL-6、IL-8的变化水平差异无统计学意义(P>0.05);中药组术后24 h的IL-10上升水平高于对照组(P<0.05);中药组术后排气时间低于西药组(P<0.05);中药组患者于术后4 h及24 h的腹痛程度较对照组相比均降低(P<0.05)。结论中药清胰利胆汤预防PEP及PEH与对照组吲哚美辛的疗效相当,能够降低PEP及PEH的发生率,促进患者术后早期排气,有效缓解患者术后腹痛程度;在一定范围内能显著提高IL-10水平,减轻炎症反应。

Objective To observe the preventive effect of Qingyi lidan mixture enema on of post ERCP pancreatitis and hyperamylasemiatoand and to explore the inflammatory factors interleukin-6,interleukin-8 and interleukin-10.Methods 96 cases were randomly divided into two groups group:the Chinese medicine group(n=48)and the western medicine group(n=48)from October 2016 to January 2019 in our hospital were selected.Routine treatment before operation in both groups,the traditional Chinese medicine group was treated with Qingyi Lidan mixture 100ml retention enema 2 hours before ERCP,western medicine group treated with 0.1g indomethacin suppository 2 hours before operation.Record the incidence of PEP andPEH,and the changes of serum amylase and IL-6,IL-8,IL-10,4 hours after operation and 24 hours after operation,and symptoms of abdominal pain,and statistical analysis.Results There was no significant difference in the incidence of PEP and PEH、serum amylase、IL-6 and IL-8 level between the traditional Chinese medicine group and the western medicine group(P>0.05).The level of IL-10 in the Chinese medicine group was significantly higher than that in the western medicine group 24h after operation(P<0.05).The exhaust time of patients in the Chinese medicine group was significantly shorter than that of the western medicine group(P<0.05).The severity of abdominal pain in the Chinese medicine group was significantly lower than that in the western medicine group at 4h and 24h after operation(P<0.05).Conclusion The efficacy of traditional Chinese medicine in the prevention of PEP and PEH is similar to that of the control drug indomethacin,reduce the incidence of PEP and PEH,promote the early exhaust of patients after operation,effectively alleviate the degree of postoperative abdominal pain and significantly improve the level of IL-10,reduce the inflammatory response.