吲哚美辛栓预防ERCP术后胰腺炎的随机对照研究  

Randomized Controlled Trial of Rectal Indomethacin Suppositories to Prevent Post-ERCP Pancreatitis

作　　者：韩耀震 聂占国[2] 雷婷[2] 热合曼江.木沙江 游云[2] 和水祥[3] 周毅[4] HAN Yaozhen NIE Zhanguo LEI Ting Rehemanjiang · MUSHAJIANG YOU Yun HE Shuixiang ZHOU Yi(Shihezi University School of Medicine, Shihezi , Xinjiang Uygur Autonomous Region （832000 Department of Gastroenterology, Urumqi General Hospital of Xinjiang Military Region of Chinese PLA, Urumqi Department of Gastroenterology, the First Affiliated Hospital of Xi＇ an Jiaotong University, Xi＇ an Department of Gastroenterology, the 451 Hospital of Chinese PLA, Xi＇an)

机构地区：[1]石河子大学医学院,832000 [2]新疆军区乌鲁木齐总医院消化科 [3]西安交通大学第一附属医院消化科 [4]解放军第451医院消化科

出　　处：《胃肠病学》2016年第9期545-548,共4页Chinese Journal of Gastroenterology

摘　　要：背景:高危人群术后直肠应用吲哚美辛栓可有效预防ERCP术后胰腺炎(PEP)发生,但高危人群、非高危人群术前用药的疗效尚不明确。目的:探讨术前、术后应用吲哚美辛栓对预防高危和非高危患者发生PEP的作用。方法:将接受ERCP的患者随机分为术前组和术后组。术前组在ERCP操作开始前30 min给予吲哚美辛栓100 mg纳肛,并进一步分为术前高危组和术前非高危组。术后高危患者在ERCP操作结束后即刻给予吲哚美辛栓100 mg纳肛,术后非高危组不用给药。观察各组PEP发生情况。结果:共纳入ERCP患者915例,其中术前高危患者127例,术前非高危患者323例,术后高危患者112例,术后非高危患者353例。术前与术后非高危患者以及术前与术后高危患者的性别、年龄、BMI、插管时间、插管次数以及相关疾病均无明显差异(P>0.05)。PEP发生率为5.0%。术前非高危组PEP发生率显著低于术后非高危组(2.5%对6.2%,P=0.018),而术前高危组与术后高危组无明显差异(6.3%对7.1%,P=0.795)。结论:非高危患者术前吲哚美辛栓纳肛可有效预防PEP的发生,高危患者术前与术后应用的预防疗效无明显差异。Postoperative indomethacin suppositories can effectively prevent the occurrence of post-ERCP pancreatitis （PEP） in high risk patients, but the prevention effect of preoperative indomethacin suppositories in high or low risk patients is not clear. Aims： To investigate the preventive effect of preoperative or postoperative indomethacin suppositories on incidence of PEP in high or low risk patients. Methods： Patients undergone ERCP were randomly divided into preoperative group and postoperative group. Patients in preoperative group were administered with rectal indomethaein suppositories （ 100 mg） 30 minutes before ERCP, and these patients were further divided into preoperative high risk group and preoperative low risk group. Patients in postoperative high risk group were administered with rectal indomethacin suppositories （100 mg） immediately after ERCP, and patients in postoperative low risk group were not administered with indomethacin suppositories. The incidence of PEP was compared. Results： A total of 915 patients were enrolled, including preoperative high risk group （n = 127） , preoperative low risk group （n = 323 ） , postoperative high risk group （n = 112 ） and postoperative low risk group （n = 353 ）. No significant differences in gender, age, BMI, intubation time, number of intubation and related disease were found between preoperative low risk group and postoperative low risk group; preoperative high risk group and postoperative high risk group （ P 〉 0.05 ）. The incidence of PEP was 5. 0%. The incidence of PEP in preoperative low risk group was significantly lower than that in postoperative low risk group （2.5% vs. 6.2% , P =0. 018） , however, no significant difference was found between preoperative high risk group and postoperative high risk group （6. 3% vs. 7. 1%, P = 0. 795）. Conclusions： Preoperative rectal indomethacin suppositories can effectively prevent the occurrence of PEP in low risk patients, however, no significant difference of PEP occurrence

关 键 词：吲哚美辛 胰胆管造影术 内窥镜逆行 胰腺炎 

分 类 号：R656[医药卫生—外科学]