经内镜逆行胰胆管造影术后并发急性胰腺炎的预防用药合理性研究

Prophylactic use of acute pancreatitis after endoscopic retrograde cholangio-pancreatography rationality study

目的观察经内镜逆行胰胆管造影术(ERCP)术后胰腺炎(PEP)发生的影响因素及常规预防用药的合理性,考察常规给予生长抑素,加贝酯以及奥曲肽对ERCP术后胰腺炎的预防效果,为ERCP围手术期合理用药提供参考。方法制定严格的纳入与排除标准,收集自2017年4月~2018年3月期间消化内科行ERCP术的83例患者为研究对象,记录患者术后2 h,24 h血清淀粉酶并观察患者是否有上腹部痛或者压痛,恶心呕吐和发热等症状,考察术后胰腺炎发生的预防效果;通过影响因素的Logistic回归分析性别、年龄、有无急性胰腺炎病史、有无胆管扩张、有无血清总胆红素的升高及是否术前给予预防用药等与ERCP术后胰腺炎发生的关系。结果通过分析83例患者ERCP术后的情况,仍然有11例(13.3%)患者出现急性胰腺炎症状。注射用甲磺酸加贝酯与醋酸奥曲肽注射液或生长抑素的使用,使急性胰腺炎症状迅速消失,患者明显好转。通过影响因素分析,年龄、性别、胆管扩张为ERCP术后胰腺炎发生的显著影响因素,其余均无显著性影响。结论ERCP术后胰腺炎发生的影响因素比较复杂,常规使用加贝酯与奥曲肽或生长抑素并不能明显降低ERCP术后胰腺炎的发生率。

Objective To observe the factors affecting post-ERCP pancreatitis and the rationality of routine preventive medication after endoscopic retrograde cholangiopancreatography(ERCP),and investigate the pancreatitis preventive effect of routine medication,including somatostatin,gabexate,octreotide after ERCP.In order to provide some referenced information for rational use of preventive medication during the operative period.Methods Our study established a strict inclusion and exclusion criteria.83 gastroenterology patients who treated with ERCP in the affiliated hospital of Xuzhou Medical University were selected as the subjects in this study,from April 2017 to March 2018.The patient's condition and observed indicator were recorded to evaluate the pancreatitis preventive effect,including the serum amylase at 2 h and 24 h after the operation,upper abdominal pain or tenderness,nausea,vomiting,fever and so on.Logistic regression was used to analyze the relationship between gender,age,history of acute pancreatitis,bile duct dilation,elevation of serum total bilirubin and preoperative prophylactic medication and the occurrence of postoperative pancreatitis after ERCP.Results After analysis the condition of 83 patients,11 patients(13.3%)present acute pancreatitis symptoms after ERCP.After injection of gabexate mesylate,octreotide acetate and somatostatin,the patient’s symptoms of acute pancreatitis rapidly vanished and the patient’s condition significantly improved.According to the analysis of influencing factors,age,sex and bile duct dilatation are the significant influencing factors of pancreatitis after ERCP,and the other factors had no significant effect.Conclusion The influencing factors of post-ERCP pancreatitis are complicated.The routine prevention medication of gabexate and octreotide or somatostatin does not significantly reduce the incidence of post-ERCP pancreatitis.