不同时期应用生长抑素预防老年患者ERCP术后消化道出血的效果及对血清胃肠激素指标的影响

Effects of somatostatin used at different time on prevention of gastrointestinal bleeding in elderly patients after ERCP and its effects on serum gastrointestinal hormone

目的探讨不同时期应用生长抑素预防老年患者经内镜逆行性胰胆管造影术(ERCP)术后消化道出血的效果及对血清胃肠激素指标的影响,为治疗该病症提供方法。方法选取2021年1月—2022年1月四川大学华西医院消化内科收治的147例拟行ERCP治疗术的老年胆胰疾病患者为研究对象,按照数表法随机分为术前组(n=47)、术后组(n=49)、全程组(n=51)。术前组为ERCP术前6h接受生长抑素治疗,术后组为术后12h内接受生长抑素治疗,全程组为术前6h至术后12h连续给予生长抑素治疗,观察并比较3组的临床疗效、炎症因子[白介素-2(IL-2)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、胃肠激素(胰高血糖素、胃泌素和胃动素)水平、不良反应发生率。结果全程组止血时间、住院时间和输血量均少于术前组和术后组(P<0.05)。治疗前,3组血清IL-2、IL-6和TNF-α水平比较差异无统计学意义(P>0.05);治疗后,3组IL-2、IL-6和TNF-α水平差异有统计学意义(P<0.001);3组血清IL-2水平较同组治疗前升高,IL-6和TNF-α水平均较同组治疗前下降,且全程组血清IL-2水平高于术前组和术后组,血清IL-6和TNF-α水平低于术前组和术后组(P<0.05)。治疗前,3组血清胰高血糖素、胃泌素和胃动素水平差异均无统计学意义(P>0.05);治疗后,3组血清胰高血糖素、胃泌素和胃动素水平差异有统计学意义(P<0.001);3组血清胰高血糖素、胃泌素和胃动素水平均较同组治疗前下降,且全程组血清胰高血糖素、胃泌素和胃动素水平均低于术前组和术后组(P<0.05)。术前组、术后组、全程组不良反应发生率分别为8.51%(4/47)、10.20%(5/49)和11.76%(6/51),差异无统计学意义(χ^(2)=0.280,P=0.868)。结论全程应用生长抑素预防老年患者ERCP术后消化道出血的效果更佳,可有效改善消化道出血症状、减少炎症反应、降低胃肠激素水平。

Objective To investigate the effects of somatostatin used at different time on prevention of gastrointestinal bleeding in elderly patients after endoscopic retrograde cholangiopancreatography(ERCP)and its effects on serum gastrointestinal hormone,and provide methods for the treatment of the disease.Methods 147elderly patients with biliary-pancreatic diseases who were scheduled to be treated with ERCP in the Department of Gastroenterology,West China Hospital,Sichuan University from January2021to January2022were selected,and randomly divided into preoperative group(n=47),postoperative group(n=49)and whole-course group(n=51)according to the number table method.The preoperative group received somatostatin treatment6hours before ERCP,the postoperative group received somatostatin treatment within12hours after ERCP,and the whole-course group received somatostatin treatment from6hours before ERCP to12hours after ERCP.The clinical efficacy,the levels of inflammatory factors[interleukin-2(IL-2),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)]and gastrointestinal hormones(glucagon,gastrin and motilin),and the incidence of adverse reactions were observed and compared among the three groups.Results The hemostasis time,hospitalization time and blood transfusion volume of the whole-course group were shorter/less than those of the preoperative group and the postoperative group(P<0.05).Before treatment,there was no significant difference in the levels of serum IL-2,IL-6and TNF-αamong the three groups(P>0.05).After treatment,there were significant differences in the levels of IL-2,IL-6 and TNF-αamong the three groups(P<0.001).The levels of serum IL-2of the three groups were higher than those of the same group before treatment,and the levels of IL-6 and TNF-αwere lower than those of the same group before treatment.Moreover,the level of serum IL-2of the whole-course group was higher than that of the preoperative group and postoperative group,and the levels of serum IL-6and TNF-αwere lower than those of the preoperative group and postoperative group(P<0.05).Before treatment,there was no significant difference in the levels of serum glucagon,gastrin and motilin among the three groups(P>0.05).After treatment,there were significant differences in the levels of serum glucagon,gastrin and motilin among the three groups(P<0.001).The levels of serum glucagon,gastrin and motilin of the three groups were lower than those of the same group before treatment,and the levels of glucagon,gastrin and motilin of the whole-course group were lower than those of the preoperative group and postoperative group(P<0.05).The incidence of adverse reactions in the preoperative group,postoperative group and whole-course group were 8.51%(4/47),10.20%(5/49)and 11.76%(6/51),respectively,without statistically significant difference(χ^(2)=0.280,P=0.868).Conclusion The application of somatostatin throughout ERCP is more effective in preventing gastrointestinal bleeding after ERCP in elderly patients,which can effectively improve the symptoms of gastrointestinal bleeding,reduce inflammatory response and reduce gastrointestinal hormone levels.