加贝酯在经皮肝穿刺胆管引流术中预防急性胰腺炎的作用  

Application of gabexate in prevention of acute pancreatitis after percutaneous transhepatic biliary drainage

作　　者：钱晓军[1] 高堃[1] 陶然[1] 戴定可[1] 翟仁友[1] 张秋红[1] 

机构地区：[1]首都医科大学附属北京朝阳医院介入放射科,100020

出　　处：《中华介入放射学电子杂志》2014年第4期30-32,共3页Chinese Journal of Interventional Radiology：electronic edition

摘　　要：目的评价采用加贝酯预防经皮肝穿刺胆管引流术(PTBD)中胰腺炎发生的应用价值。方法纳入观察38例,为防止急性胰腺炎的发生,14例患者手术前30 min^2 h开始使用加贝酯300 mg,引流术后6 h禁食,观察患者有无腹痛等症状,观察血淀粉酶的变化。22例未使用加贝酯作为对照,同样引流术后6 h禁食,观察患者有无腹痛等症状,观察血淀粉酶的变化。当出现胰腺炎时给予培新每次0.1g,一日2~3次,同时监测血尿淀粉酶的变化。结果加贝酯组14例中发生血淀粉酶升高1例,对照组24例中发生急性胰腺炎10例,术前使用加贝酯与不使用加贝酯急性胰腺炎发生率的差异有统计学意义(P<0.05)。讨论对于放置内外引流时,应适当采用胰酶抑制剂(加贝酯),可有效防治急性胰腺炎并发症的发生,使用该药物的价格性能比及大样本实验仍有待进一步研究。Objective To evaluate the clinical use of gabexate for preventing pancreatitis during percutaneous transhepatic biliary drainage（PTBD） by external drainage and internal drainage. Methods A total of 38 patients with malignant obstructive jaundice were studied of which external and internal drainage will be placed or biliary stents will be placed. 300 mg gabexate was used in order to prevent the occurrence of acute pancreatitis in 14 patients 30 min to 2 h before the PTBD procedure. A total of 24 patients without gabexate were included as the control group. After 6 h of fasting, blood amylase was exam for pancreatitis diagnosis with or without abdominal pain, and other symptoms. Once pancreatitis was diagnosed, octreotide acetate 0.1 g was used per times, 2~3 times a day, while the changes of serum and urine amylase was surveyed. Results Only 1 case in gabexate group was found with blood amylase increasing, while 10 patients of pancreatitis in control group. The incidence of acute pancreatitis were significantly different（P〈0.05）. Conclusions Appropriate use of trypsin inhibitor（gabexate mesilate）, which can effectively prevent the occurrence of complications of acute pancreatitis when external and internal drainage should be appropriate placed. However, the use of the drug rice-performance ratio is still subject to further investigation and a large sample would be included.

关 键 词：胰酶抑制剂 黄疸 梗阻性 胰腺炎 

分 类 号：R576[医药卫生—消化系统]