胰管内注射乌司他丁对实验犬ERCP术后胰腺损伤的预防  

Infusion of ulinastatin via the pancreatic duct for prophylaxis of pancreatic injury after endoscopic retrograde cholangiopancreatography in dogs

作　　者：吕志武[1] 李易晨[1] 贾莉[1] 迟宝荣[2] 

机构地区：[1]哈尔滨医科大学附属第二医院消化内科,黑龙江省哈尔滨市150086 [2]吉林医学院第一医院消化内科,吉林省长春市130021

出　　处：《世界华人消化杂志》2012年第6期467-472,共6页World Chinese Journal of Digestology

摘　　要：目的:评价胰管内注射乌司他丁对内镜逆行胆胰管造影术(encoscopic retrograde cholangio-pancreatography,ERCP)术后胰腺损伤的预防作用.方法:将实验犬随机分为3组,分别为乌司他丁组(A组)、生理盐水组(B组)、对照组(C组),每组8只.在麻醉状态下行ERCP检查,内镜通过幽门,在十二指肠降段找到十二指肠乳头开口后,A、B两组导丝插入胆管,并向胆管内注入三代显10.0 mL胆管显影后,将导丝选择性插入胰管,A组注入向胰管内缓慢注入乌司他丁10万单位(2.0 mL)(溶于0.9%氯化钠8.0 mL)、B组向胰管内缓慢注入0.9%氯化钠10.0 mL.5 min后,A、B两组均在1 min内注入三代显10.0 mL,使胰管显影;C组将导丝插入胆管,并向胆管内注入三代显10.0 mL,胰管不插管.3组实验犬术后定时采静脉血,生化仪测量血淀粉酶含量,ELISA方法测定3组各时段IL-6、IL-8及胰蛋白酶原激活肽的含量.于ERCP术后第6天处死所有动物,取胰腺标本进行组织学检查.比较各组组织病理学指标的变化情况,综合判断ERCP术后胰腺损伤的发生情况.结果:(1)E R C P术后2 h A组血清淀粉酶、I L-6、I L-8及T A P值分别为3 9 1.0 U/L±67.2 U/L,51.91 ng/L±4.87 ng/L,4.070μg/L±0.089μg/L,3.234 nmol/L±0.185 nmol/L,B组分别为1 077.0 U/L±246.1 U/L,78.11 ng/L±11.25 ng/L,4.520μg/L±0.195μg/L,4.001 nmol/L±0.237 nmol/L,IL-6及IL-8随时间延长而逐渐降低,TAP及血清淀粉酶在24 h达峰值,后逐渐降低,与C组相比均有升高,B组各值均高于A组;(2)胰腺病理学检测结果:A组损害较B组无明显差异.结论:胰管内注射乌司他丁可以使ERCP术后胰腺损伤的发病情况减轻.AIM：To evaluate the prophylactic effect of infusion of ulinastatin via the pancreatic duct on pancreatic injury after endoscopic retrograde cholangiopancreatography（ERCP） in a canine model.METHODS：Twenty-four dogs were randomized into three groups：ulinastatin group（group A）,iobitridol group（group B） and normal group（group C）.A duodenoscope was routinely inserted to the duodenal papilla under general anesthesia in dogs of each group.A guide wire was introduced into the bile duct in groups A and B to inject 10.0 mL of iobitridol,and the guide wire was then introduced into the pancreatic duct to slowly administer 100？000 units of ulinastatin and 8.0 mL of sodium chloride in group A and 10.0 mL of sodium chloride in group B.Five minutes later,10.0 mL of iobitrdol was transfused into the pancreatic ducts in both groups within less than 1 min.A guide wire was introduced into the bile duct in group C to administer 10.0 mL of iobitridol.The contents of serum IL-6,IL-8,amylase and plasma TAP were determined by ELISA.Pancreatic tissues were pathologically examined 6 days after ERCP.RESULTS：The contents of serum IL-6,IL-8,amylase and plasma TAP were significantly lower in group A than in group B（391.0 U/L ± 67.2 U/L vs 1？077.0 U/L ± 246.1 U/L,51.91 ng/L ± 4.87 ng/L vs 78.11 ng/L ± 11.25 ng/L,4.070 μg/L ± 0.089 μg/L vs 4.520 μg/L ± 0.195 μg/L,3.234 nmol/L ± 0.185 nmol/L vs 4.001 nmol/L ± 0.237 nmol/L（all P 0.05）,and significantly higher in groups A and B than in group C.Under light microscopy,the pathological changes in pancreatic tissues in the ulinastatin group were less significant than those in other groups.CONCLUSION：Pancreatic injury induced by ERCP could be ameliorated effectively and safety by infusion of ulinastatin via the pancreatic duct in dogs.

关 键 词：胰腺损伤 乌司他丁 内镜逆行胆胰管造影 

分 类 号：R657.51[医药卫生—外科学]