硝酸甘油预防ERCP术后胰腺炎及高淀粉酶血症的临床应用研究  

Clinical Study of Nitroglycerin in Preventing Pancreatitis and Hyperamylasemia after ERCP

作　　者：刘双[1] 刘军[2] 孙文生[1] 张锎[1] 孙斌[1] 谢朝波[1] 张明[1] 柳莉[1] 

机构地区：[1]山东省交通医院肝胆外科,济南250031 [2]山东大学附属省立医院器官移植肝胆外二科,济南250021

出　　处：《中国普外基础与临床杂志》2009年第8期641-644,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨硝酸甘油对经内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)和高淀粉酶血症的预防作用。方法选择2008年1～12月在山东省交通医院肝胆外科住院治疗、经CT或MRI证实为胆总管结石、拟实施ERCP、经内镜乳头括约肌切开术(EST)及经内镜取石的患者100例,按照随机数字表法随机分为硝酸甘油组(n=50)与对照组(n=50),检测2组患者术前、术后3 h和24 h血清淀粉酶水平以及术后高淀粉酶血症和PEP的发生情况。结果2组患者术前血清淀粉酶水平的差异无统计学意义(P>0.05),2组患者术后3 h和24 h血清淀粉酶水平均高于术前水平(P<0.01),但硝酸甘油组术后3 h及24 h血清淀粉酶水平〔(108.88±152.07)U/L,(97.02±113.38)U/L〕均分别显著低于对照组术后3 h及24 h血清淀粉酶水平〔(196.30±244.41)U/L,(234.22±406.05)U/L〕,P<0.05。硝酸甘油组ERCP术后的高淀粉酶血症发生率(12.00%,6/50)和PEP发生率(2.00%,1/50)均分别显著低于对照组〔高淀粉酶血症30.00%(15/50),PEP 14.00%(7/50)〕,P<0.05。结论舌下含化硝酸甘油可降低ERCP术后血清淀粉酶水平,对PEP及高淀粉酶血症均有预防作用。Objective To investigate the effect of nitroglycerin on preventing post-endoscopic retrograde cholangiopancreatograph （ERCP） pancreatitis （PEP） and hyperamylasemia. Methods One hundred patients diagnosed as common bile duct stones by CT or MRI and planned to undergo ERCP, EST and stones removal under endoscopy were selected from January to December 2008 in Shandong Jiaotong Hospital. These patients were randomly divided into 2 groups： nitroglycerin group （n=50）, in which 0.5 mg nitroglycerin was given sublingually in 5--10 min before ERCP; control group （n=50）, in which no nitroglycerin was given. The levels of serum amylase of all the patients before ERCP and at 3 h, 24 h after ERCP were detected and the incidence of hyperamylasemia and PEP were also observed. Results The level of serum amylase between 2 groups before ERCP was not significantly different （P〉0.05）. The levels of serum amylase at 3 h and 24 h after ERCP were significantly higher than that before ERCP in 2 groups. The level of serum amylase in nitroglycerin group were respectively lower than that in control group at 3 hand 24 h after ERCP [3 h： （108.88±152.07） U/L vs. （196. 30 ± 244. 41） U/L; 24 h： （97. 02± 113.38） U/L vs. （234.22±406.05） U/L], P〈0.05. The incidence of hyperamylasemia （12.00%, 6/50） and PEP （2.00%, 1/50） in nitroglycerin group was respectively significantly lower than that in control group （hyperamylasemia： 30.00% , 15/50; PEP： 14.00%, 7/50）, P〈0.05. Conclusion Sublinguat nitroglycerin can decrease the level of serum amylase and prevent PEP and hyperamylasemia.

关 键 词：硝酸甘油 经内镜逆行胰胆管造影 胰腺炎 高淀粉酶血症 

分 类 号：R657.51[医药卫生—外科学]