双氯芬酸钠联合生大黄对ERCP术后胰腺炎的预防作用

Preventive Effect of Diclofenac Sodium Combined with Rhubarb on Pancreatitis after ERCP

目的:观察双氯芬酸钠联合生大黄对经内镜逆行性胰胆管造影(ERCP)术后胰腺炎的预防效果。方法:前瞻选取2019年1月-2020年12月在本院行ERCP取石术治疗的120例胆总管结石(合并或不合并胆囊结石)患者,依据随机数字表法分为对照组和观察组,各60例。对照组术后实施常规预防,观察组术后使用双氯芬酸钠联合生大黄预防。记录两组ERCP术后胰腺炎发生情况;检测并对比两组术前及术后3、24 h血淀粉酶水平;检测并对比两组术后24 h的C反应蛋白(CRP)水平、白细胞计数(WBC)、中性粒细胞、淋巴细胞及单核细胞数目等血常规指标;记录并对比两组腹胀痛缓解时间、肠鸣音恢复正常时间等腹部体征恢复情况和通便时间;记录两组术后不良反应发生情况。结果:观察组ERCP术后胰腺炎发生率低于对照组,但组间比较差异无统计学意义(P>0.05);两组术后3 h血淀粉酶水平均较术前升高,但在术后24 h回降,且观察组术后各时点水平均低于对照组,差异均有统计学意义(P<0.05);术后24 h,观察组CRP、WBC、中性粒细胞、淋巴细胞、单核细胞水平均低于对照组,差异均有统计学意义(P<0.05);观察组腹胀痛缓解时间、肠鸣音恢复正常时间、通便时间均短于对照组,差异均有统计学意义(P<0.05);两组术后不良反应发生率对比,差异无统计学意义(P>0.05)。结论:双氯芬酸钠联合生大黄更有利于降低ERCP手术患者术后血清淀粉酶水平,控制炎症反应,腹部体征及通便时间均缩短,更利于预防术后胰腺炎,且也不会增加不良反应风险,安全性好。

Objective:To observe the preventive effect of Diclofenac Sodium combined with Rhubarb on pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP).Method:A total of 120 patients with common bile duct stone(with or without cholecystolithiasis)who underwent ERCP for treatment from January 2019 to December 2020 in our hospital were prospectively selected,they were divided into the control group and the observation group by the random number table method,60 cases in each group.The control group was given routine prevention after operation,and the observation group was given Diclofenac Sodium combined with Rhubarb for prevention after operation.The occurrence of pancreatitis after ERCP between two groups was recorded.The blood amylase levels of two groups were detected and compared before operation,3 h and 24 h after operation.The levels of C-reactive protein(CRP),white blood cell count(WBC),number of neutrophils,lymphocytes and monocytes were detected and compared between two groups 24 h after operation.The recovery of abdominal signs and defecation time between two groups were recorded and compared.The occurrence of postoperative adverse reactions between two groups were recorded.Result:The incidence of pancreatitis after ERCP in the observation group was lower than that in the control group,but there was no statistical significant difference(P>0.05).The blood amylase level of two groups was increased 3 h after operation,but was decreased 24 h after operation,and the levels of the observation group were lower than that of the control group at each time point after operation,there were statistical significant differences(P<0.05).24 h after operation,the levels of CRP,WBC,neutrophils,lymphocytes and monocytes in the observation group were lower than those in the control group,there were statistical significant differences(P<0.05).The abdominal pain relief time,bowel sound recovery time and defecation time of the observation group were shorter than those of the control group,there were statistical significant differences(P<0.05).Compared the total incidence of postoperative adverse reactions between two groups,there was no statistical significant difference(P>0.05).Conclusion:Diclofenac Sodium combined with Rhubarb is beneficial to reduce the postoperative serum amylase level,control the inflammatory reaction,the abdominal signs and defecation time of the patients are shortened,is more conducive to the prevention of postoperative pancreatitis,and the risk of adverse reactions will not be increased,with high safety.