不同剂量吲哚美辛栓对减少内镜下逆行胰胆管造影术后胰胆炎的价值  

The value of different doses indometacin on reducing post-encoscopic retrograde cholangio-pancreatography pancreatitis

作　　者：江志俊 连小玲 郑丽娟[1] 林卫星[1] 吴以龙[1] JIANG Zhi-jun;LIAN Xiao-ling;ZHENG Li-juan;LIN Wei-xing;WU Yi-long(Fuding Hospital,Fuding City,Fujian,355200,China)

机构地区：[1]福鼎市医院消化内科,福建福鼎355200

出　　处：《临床消化病杂志》2018年第6期373-377,共5页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]探讨内镜下逆行胰胆管造影术(encoscopic retrograde cholangio-pancreatography,ERCP)前应用不同剂量吲哚美辛栓对减少ERCP后胰腺炎(PEP)的临床价值。[方法]纳入确诊为胆总管结石的269例患者,并随机分成A组(90例)、B组(90例)、C组(89例)。A组常规基础治疗+ERCP前30min、100mg吲哚美辛栓塞肛,B组常规基础治疗+ERCP前30min、50mg吲哚美辛栓塞肛,C组常规基础治疗+ERCP前30min安慰剂维生素C100mg塞肛,观察各组出现的新症状、体征(腹痛、腹胀、恶心呕吐、发热、腹部压痛及反跳痛)或原有症状加重情况,比较各组ERCP后3h、12h、24h、48h血清淀粉酶,判断PEP、高淀粉酶血症发生率。[结果]A组、B组、C组ERCP后新出现的症状、体征或原有症状加重的发生率分别为6.7%、10.0%、21.1%,A组、B组明显低于C组(P<0.05);A组、B组、C组PEP发生率为2.2%、3.3%、16.9%;高淀粉酶血症发生率为13.3%、18.9%、31.5%,A组、B组明显低于C组(P<0.05);A组、B组ERCP后3h、12h、24h、48h血清淀粉酶均低于C组,差异有统计学意义(P<0.05)。A组ERCP后血清淀粉酶及新出现的症状、体征或原有症状加重的发生率,高淀粉酶血症、PEP发生率均低于B组,但2组比较差异无统计学意义(P>0.05)。[结论]ERCP前30min吲哚美辛栓塞肛可以减少PEP的发生率,100mg与50mg吲哚美辛栓塞肛对降低PEP的疗效相当。故可应用小剂量(50mg)吲哚美辛栓肛栓。[Objective]To investigate the clinical value of different doses indometacin on reducing postencoscopic retrograde cholangio-pancreatography(ERCP).[Methods]The totals of 269 patients of choledocholithiasis were enrolled from 2016-01-01 to 2017-01-01 in our hospital,and these patients were divided into group A(90 cases),group B(90 cases)and group C(89 cases).Group A were treated by basic therapy combined with indometacin(100 mg)30 minutes before ERCP.Group B were treated by basic therapy combined with indometacin(50 mg)30 minutes before ERCP.Group C were treated by basic therapy combined with Placebo(100 mg vitamin C)30 minutes before ERCP.The onset symptoms and signs,including abdominal pain,abdominal distension,nausea,vomiting,fever,abdominal tenderness,rebound pain,or aggravation of previous symptoms were observed.The serum amylase of 3 h,12 h,24 hand 48 hafter ERCP among the three groups were compared.The incidence of post-ERCP pancreatitis(PEP)and high amylase were determined.[Results]The incidence of new symptoms,signs in group A and group B were 6.7%,10% respectively,which were significantly lower than that in group C(21.1%,P<0.05).The incidence of PEP were 2.2%,3.3%,16.9% respectively.The incidence of hyperamylase were 13.3%,18.9%,31.5% respectively,the incidence of PEP,hyperamylase in group A and group B were lower than group C(P< 0.05).The serum amylase of 3 h,12 h,24 hand 48 hafter ERCP in group A,group B were lower than group C(P<0.05).However,no significant difference was found between group A and group B(P>0.05).[Conclusion]The incidence of PEP was reduced by using indometacin 30 min before ERCP,but the effect of different doses of indometacin were comparable.

关 键 词：胰腺炎 吲哚美辛栓 内镜下逆行胰胆管造影术 

分 类 号：R576[医药卫生—消化系统]