新型NSAIDs药物对ERCP术后胰腺炎发生的影响  

Effects of new-type NSAIDs in preventing post-ERCP pancreatitis

作　　者：王安[1] 蔡旺[2] 秦鸣放[2] 李宁[2] 

机构地区：[1]天津医科大学研究生院,天津市300100 [2]天津市南开医院微创外科,天津市300100

出　　处：《世界华人消化杂志》2013年第34期3881-3886,共6页World Chinese Journal of Digestology

基　　金：天津市卫生局科技基金资助项目;No.2013KZ054~~

摘　　要：目的:观察新型和传统非甾体类抗炎药(nonsteroid anti-inflammtory drugs,NSAIDs)药物对预防经内镜逆行性胰胆管造影术(endoscopic rectrograde cholangiopancreatography,ERCP)后胰腺炎发生、减轻术后高胰酶血症、缓解术后疼痛的作用.方法:入选2012-05/2013-05于我院行十二指肠镜治疗的胆总管结石患者197例,随机分为氯诺昔康组、帕瑞昔布组和对照组.内镜治疗前后采用新型NSAIDs帕瑞昔布钠及传统NSAIDs氯诺昔康静脉注射.所有患者术前、术后4、24、48 h监测血清淀粉酶、C反应蛋白(C-reactive protein,CRP),并同时记录视觉模拟评分法(visual analogue score,VAS)疼痛评分.结果:帕瑞昔布组、氯诺昔康组和对照组PEP发生率分别为4.55%、9.09%、10.8%,两种NSAIDs药物组内镜后胰腺炎(post ERCP pancreatitis,PEP)发生率均比对照组低,其中帕瑞昔布组与对照组的差异有统计学意义(P<0.05).帕瑞昔布组高胰酶血症发生率(9.09%)与对照组(21.5%)相比有显著统计学差异(P<0.01),氯诺昔康组高胰酶血症发生率(15.2%)与对照组(21.5%)相比,差异有统计学意义(P<0.05).术后4 h帕瑞昔布组和氯诺昔康组的血清CRP水平(23.41 mg/L±14.07 mg/L、36.35 mg/L±15.75 mg/L),均比同时相对照组(58.35 mg/L±19.07 mg/L)低,且差异有显著统计学差异(P<0.01),术后24 h两组的血清CRP水平(13.63 mg/L±11.73 mg/L、21.39 mg/L±13.38 mg/L),均比同时相对照组(48.10 mg/L±18.42 mg/L)低,且差异有统计学意义(P<0.05).术后4 h的VAS疼痛评分帕瑞昔布组(2.73±1.34)、氯诺昔康组(3.28±1.27)均比对照组(6.45±1.89)低,且差异有显著统计学意义(P<0.01).结论:帕瑞昔布和氯诺昔康可减少内镜后高胰酶血症的发生,其中帕瑞昔布可能能预防内镜后胰腺炎发生.两种方法都可以减轻内镜术后的疼痛和炎症反应.提示新型NSAIDs药物即选择性环氧合酶-2抑制剂在预防内镜后胰腺炎方面有一定应用前景.AIM： To compare the effects of new-type versus traditional non-steroid antiinflammtory drugs （NSAIDs） in the prevention of post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP）. METHODS： One hundred and ninety-seven pa- tients who underwent ERCP for choledocholithi- asis between May 2012 and May 2013 were ran- domly divided into three groups： a lornoxicam group, a parecoxib group and a control group. Different drugs were applied for each group. Mean visual analogue score （VAS） and serum levels of amylase and C-reactive protein （CRP） were measured before ERCP and 4, 24 and 48 h after ERCP~ Incidences PEP were observed of hyperamylasemia andRESULTS： The incidences of PEP in the lornoxi- cam group, parecoxib group and control group were 4.55%, 9.09% and 10.8%, respectively, and the difference was statistically significant be- tween the parecoxib group and control group （P 〈 0.05）, but not between the lornoxicara group and control group （P 〉 0.05）. The incidences of post-ERCP hyperamylasemia in the parecoxib group and lornoxicam group were significantly lower than that in the control group （9.09%, 15.2% vs 21.5%, both P 〈 0.01）. Serum CRP level at 4 h after ERCP was significantly lower in both treatment groups than in the control group （both P 〈 0.01）. Mean VAS at 4 h after ERCP was sig- nificantly lower in both treatment groups than in the control group （both P 〈 0.01）. CONCLUSION： NSAIDs like lornoxicarn and parecoxib can prevent the occurrence of hyper- amylasemia induced by ERCP. Parecoxib could prevent the occurrence of PEP. Both drugs can alleviate pain and inflammatory reactions after the endoscopic procedure. As a new type of NSAIDs, selective cyclooxygenase-2 （COX-2） inhibitors might be more useful in preventing PEP.

关 键 词：内窥镜逆行性胰胆管造影术 胰腺炎 高胰 酶血症 非甾体类抗炎药物 

分 类 号：R657.5[医药卫生—外科学]