马来酸曲美布汀对内镜逆行胰胆管造影术后胰腺损伤影响的随机对照研究  

Randomized controlled study of the influence of maleates trimebutine on the post-endoscopic retrograde cholangiopancreatography pancreatic injury

作　　者：白熙[1] 郝建宇[1] 

机构地区：[1]首都医科大学附属北京朝阳医院消化科,100020

出　　处：《中华临床医师杂志（电子版）》2013年第15期59-62,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨马来酸曲美布汀对内镜逆行胰胆管造影(ERCP)术后胰腺损伤发病率的影响及安全性。方法入选我院自2012年6至12月收治的拟施行ERCP患者72例。患者随机分为马来酸曲美布汀组(n=36)和对照组(n=36)。术前60 min两组患者分别口服马来酸曲美布汀200 mg及安慰剂(维生素C0.2 g)。观察ERCP术后血清淀粉酶水平及胰腺炎、高淀粉酶血症发生情况,观察术后腹痛黄疸情况及不良反应。结果马来酸曲美布汀组血清淀粉酶低于对照组,术后2 h两组差异有统计学意义(P=0.037)。72例中,ERCP术后急性胰腺炎(PEP)发生率为6.94%(5例),高淀粉酶血症发生率为26.4%(19例)。其中,胰腺炎的发生率,马来酸曲美布汀组低于对照组(5.6%vs.8.3%),但差异无统计学意义(χ2=1.687,P=0.134)。高淀粉酶血症的发生率,马来酸曲美布汀组低于对照组(19.4%vs.33.3%),差异有统计学意义(χ2=5.016,P=0.025)。马来酸曲美布汀组ERCP术后腹痛分级明显低于对照组,两组差异有显著性(P=0.008)。马来酸曲美布汀组ERCP术后直接胆红素(DBIL)与对照组同期比较有下降,差异有统计学意义(P=0.047)。但ERCP术后胆管炎发生率两组比较差异无统计学意义(P=0.178)。两组均未出现严重不良反应。结论 ERCP术前口服马来酸曲美布汀对降低术后高淀粉酶血症的发生有益;并能辅助减轻腹痛。马来酸曲美布汀药物安全性好。Objective To study the impact on post-endoscopic retrograde cholangiopancreatography （ERCP） pancreatic injury with maleates trimebutine. Methods From June to December 2012 total 72 patients with normal serum amylase and without cholangitis underwent ERCP were admitted in our hospital. The patients were randomly divided into rnaleates trimebutine group（36 cases） and control group（36 cases）, 2 groups were given 200 mg maleates trimebutine or Vitamin C 0.2 g at 60 minutes before ERCP. The mean concentrations of serum amylase at 2 h, 24 h and 48 h after ERCP were measured in all patients. The incidence of PEP and hyperamylasemia and adverse reactions were observed.The abdominal pain and stained yellow before and after ERCP were also observed. Results The serum amylase level of maleates trimebutine group was lower than the controls. There was a difference between the two groups at 2 h after ERCP（P=0.037）. The overall incidences of PEP and bypcramylasemia were 6.94%（5/72）and 26.4%（19/72）. Respectively, the incidence of hyperamylasemia in maleates trimebutine group（7/36, 19.4%）was significantly lower than that of control group（12/36,33.3%）（χ3= 5.016, P=0.025）. Incidence of PEP in maleates trimebutine group（2/36,5.6%）was lower than that of control group（3/36, 8.3%） without significance（χ2= 1.687, P= 0.134）. The abdominal pain grading of maleates trimebutine group was lower than the controls.There was a significant difference（P=0.008）. The DBIL level of maleates trimebutine group were lower than the controls. There was a difference（P= 0.047）. But the inciden.ce of cholangitis had no difference （P=0.178）. No severe adverse effects was observed. Conclusions Maleates trimebutine is used in pre-ERCP may be beneficial for reducing the incidence of hyperamylasemia and can help to reduce abdominal pain.Maleates trimebutine is safe.

关 键 词：胰胆管造影术 内窥镜逆行 胰腺炎 高淀粉酶血症 马来酸盐类 

分 类 号：R575.6[医药卫生—消化系统]