山莨菪碱和加贝酯对胆总管结石术后胆道动力的影响  

Effects of anisodamine and gabexate mesilate on biliary dynamics in patients after biliary operation

作　　者：周迈[1] 郭晏同[2] 常迎彬[1] 钟朝辉[3] 

机构地区：[1]民航总医院普外科,北京市100123 [2]北京大学第四临床医学院北京积水潭医院普外科,北京市100035 [3]北京大学人民医院普外科,北京市100044

出　　处：《世界华人消化杂志》2009年第26期2748-2751,共4页World Chinese Journal of Digestology

摘　　要：目的:观察胆总管结石术后,使用山莨菪碱、加贝酯对胆道和机体的影响.方法:将胆总管结石术后患者65例,随机分为对照组(n=20),山莨菪碱组(n=22)和加贝酯组(n=23),分别于术后1、2、3、4、5及7d检测胆道压力及血清中内毒素的变化.于术后3、7d进行99mTc-EHIDA肝胆动态功能显像定量分析.结果:胆道压力术后1、2、3d,加贝酯组的低于对照组(1.76±0.20kPavs1.84±0.28kPa;1.60±0.221kPavs1.86±0.20kPa;1.56±0.22kPavs1.74±0.24kPa,均P<0.05);术后3、4d,山莨菪碱组和加贝酯组血清中内毒素水平低于对照组(P<0.05);术后3d,30min十二指肠显影率(DAR)山莨菪碱组、加贝酯组与对照组间有明显差异(P=0.026,0.018);而肝高峰摄取时间(Tmax)、半排时间(T1/2)、胆总管高峰摄取时间(Tmax)及半排时间(T1/2)差异无显著性.结论:本研究提示术后早期,山莨菪碱组、加贝酯等药物可以促进胆汁排泄,降低血清内毒素水平,其作用机制可能与改善术后Oddi括约肌功能有关.AIM： To observe the effects of anisodamine and gabexate mesilate on biliary dynamics in patients after biliary operation. METHODS： Sixty-five patients after choledochotomy were randomly divided into control group （n = 20）, anisodamine treatment group （n = 22） and gabexate mesilate treatment group （n = 23）. Plasma endotoxin level and bile duct pressure were measured on days 1, 2, 3, 4, 5 and 7 after operation, respectively. Hepatobiliary function was evaluated using quantitative 99mTc- EHIDA hepatobiliary scintigraphy on days 3 and 7 after operation. RESULTS： The bile duct pressure in patients in the gabexate mesilate treatment group was lower than that in the control group on days 1, 2 and 3 after operation （1.76 ± 0.20 kPa vs 1.84 ± 0.28 kPa, 1.60 ± 0.221 kPa vs 1.86 ± 0.20 kPa, and 1.56 ± 0.22 kPa vs 1.74 ± 0.24 kPa, respectively; all P 〈 0.05）. Plasma endotoxin levels in patients in the two treatment groups were lower than those in the control group on days 3 and 4 after operation （all P 〈 0.05）. On day 3, the rates of duodenal appearance over 30 min in the two treatment groups were significant higher than that in the control group （P = 0.026 and 0.018, respectively）. However, no significant differences were noted in the time to peak activity （Tmax） and the half-time of excretion （T1/2） of the liver and common bile duct among the three groups. CONCLUSION： Anisodamine and gabexate mesilate can promote bile excretion and reduce plasma endotoxin level in the early period after choledochotomy perhaps through improving the function of sphincter of oddi.

关 键 词：山莨菪碱 加贝酯 胆道动力学 胆道手术 放射性核素显像 内毒素 

分 类 号：R657.4[医药卫生—外科学]