非甾体消炎药对ERCP术后胰腺炎高危患者的预防作用

Preventive effect of non-steroidal anti-inflammatory drugs on patients with high risk of post-ERCP pancreatitis

目的:探讨经内镜逆行胰胆管造影(ERCP)术中运用非甾体消炎药(NSAIDS)对ERCP术后胰腺炎(PEP)高危患者的预防作用。方法:回顾分析2011-05~2016-05我院行ERCP治疗的患者258例,依据纳入与排除标准,分为NSAIDS纳肛组和对照组。对比分析两组ERCP术后高淀粉酶血症、PEP、腹痛、消化道出血等发生率以及血清C反应蛋白、淀粉酶的变化。结果:NSAIDS组术后新增腹痛例数、PEP例数明显少于对照组(P<0.05),术后重症胰腺炎发生率具有减低的趋势;NSAIDS的运用并未增加消化道出血的风险。与对照组相比,NSAIDS运用后患者术后4、24 h血淀粉酶及C反应蛋白升高程度较低(P<0.05)。结论:对于ERCP术中确认的PEP高风险患者,及时给予NSAIDS纳肛可减少PEP的发生,具有较好的临床应用价值。

Objective:To explore the preventive effect of non-steroidal anti-inflammatory drugs(NSAIDS) on patients with high risk of post-ERCP pancreatitis(PEP). Methods:A total of 258 patients with ERCP treatment from May 2011 to May 2016 in our department were selected and randomly divided into NSAIDS group and control group according to the inclusion and exclusion criteria. The incidences of postoperative hyperamylasemia,PEP,abdominal pain,gastrointestinal bleeding and the changes of serum C-reactive protein and amylase were compared between the two groups after ERCP. Results:Cases with abdominal pain and PEP were significantly less in NSAIDS group than those in control group after ERCP(P < 0. 05). Incidence of severe acute pancreatitis showed a decreased tendency,and the use of NSAIDS did not increase the risk of gastrointestinal bleeding. Levels of serum amylase and C-reactive protein 4 and 24 h after ERCP increased less obviously in NSAIDS group than those in control group after ERCP(P < 0. 05). Conclusion:Rectal administeration of NSAIDS may reduce the incidence of PEP and is valuable in clinical parctice for patients with high risk of PEP during ERCP.