不同剂量吲哚美辛术前给药预防ERCP术后胰腺炎的临床研究

Preoperative Rectal Administered of Different Doses of Indomethacin to Prevent Post-ERCP Pancreatitis

目的探讨不同剂量吲哚美辛术前给药在预防内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术后胰腺炎中的安全性和有效性。方法选取2018-01/2019-03月,拟行ERCP且术前评估为术后发生胰腺炎风险属高危的患者180例,根据术前不同给药剂量分为50 mg组和100 mg组,各90例。50 mg组术前30 min内给予吲哚美辛栓50 mg纳肛,100 mg组术前30 min内给予吲哚美辛栓100 mg纳肛。两组其他围手术期用药和管理方案相同。观察两组ERCP术后胰腺炎发生率及其严重程度、高淀粉酶血症以及吲哚美辛相关不良反应和ERCP术后其他并发症发生率。结果 50mg组和100mg组ERCP术后胰腺炎发生率相当(8.89%vs.7.78%),组间比较差异无统计学意义(χ~2=0.073,P=0.787)。50 mg组和100 mg组轻、中、重度急性胰腺炎例数分别为6、2、0例和6、1、0例,组间比较差异无统计学意义(χ~2=0.267,P=0.875)。50 mg组ERCP术后高淀粉酶血症发生率显著高于100 mg组(28.9%vs. 15.6%),组间比较差异有统计学意义(χ~2=4.629,P=0.031)。50 mg组和100 mg组吲哚美辛相关不良反应发生率分别为3.33%和11.11%,组间比较差异有统计学意义(χ~2=4.063,P=0.044)。两组ERCP术后穿孔、感染、出血发生率差异无统计学意义(P>0.05)。结论 50 mg与100 mg吲哚美辛术前纳肛,预防ERCP术后胰腺炎的效果基本相当,且50 mg吲哚美辛可能有助于降低不良反应,但预防ERCP术后高淀粉酶血症的作用稍逊于100 mg。

Objective To investigate the safety and efficacy of different doses of indomethacin before operation in preventing post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis.Methods A total of 180 patients underwent ERCP and had elevated risk of post-ERCP pancreatitis from January 2018 to March 2019 were collected and randomly divided into 50 mg group and 100 mg group according to different doses before operation,with 90 cases in each group.The 50 mg group was given 50 mg indomethacin suppository in anus within 30 minutes before operation,and the 100 mg group was given 100 mg indomethacin suppository in anus within 30 minutes before operation.The other perioperative medication and management schemes of the two groups were same.The incidence and severity of post-ERCP pancreatitis,hyperamylasemia and the incidence of indomethacin-related adverse reactions,and the other complications after ERCP were observed.Results The incidence of post-ERCP pancreatitis in 50 mg group and 100 mg group was similar(8.89%vs.7.78%),and there was no significant difference(χ~2=0.073,P=0.787).The cases of mild,moderate and severe post-ERCP pancreatitis in 50 mg group and 100 mg group were 6,2,0 and 6,1 and 0,respectively,which were no significant difference(χ~2=0.267,P=0.875).The incidence of hyperamylasemia after ERCP in 50 mg group was significantly higher than that in 100 mg group(28.9%vs.15.6%)(χ~2=4.629,P=0.031).The incidence of indomethacin-related adverse reactions in 50 mg group were lower than those in 100 mg group(3.33%vs.11.11%)(χ~2=4.063,P=0.044).There were no significant difference in the incidence of perforation,infection and hemorrhage after ERCP between the two groups(P>0.05).Conclusion The effect of 50 mg indomethacin on preventing post-ERCP pancreatitis is basically similar to that of 100 mg,and 50 mg is helpful to reduce adverse reactions,but the effect of preventing hyperamylasemia after ERCP is slightly less than that of 100 mg.