4种蛋白酶抑制剂预防胆总管结石患者ERCP术后高淀粉酶血症和胰腺炎的成本-效果分析  

Cost-effectiveness Analysis of 4 Kinds of Protease Inhibitor Preventing Hyperamylasemia and Pancreatitis after ERCP of Choledocholithiasis Patients

作　　者：王桂良[1] 邱萍[1] 徐林芳[1] 李兴[1] 文萍[1] 龚敏[1] 文剑波[1] 

机构地区：[1]萍乡市人民医院/赣南医学院附属萍乡医院消化内科,江西萍乡337000

出　　处：《中国药房》2017年第14期1880-1884,共5页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81360080)

摘　　要：目的:评价生长抑素、乌司他丁、奥曲肽和加贝酯预防胆总管结石患者内镜逆行胰胆管造影(ERCP)术后高淀粉酶血症和胰腺炎的经济性。方法:收集我院2008年7月-2016年4月经ERCP诊疗的316例胆总管结石患者的病历资料,按蛋白酶抑制剂使用情况分成空白对照组(58例)、生长抑素组(64例)、乌司他丁组(65例)、奥曲肽组(68例)和加贝酯组(61例)。ERCP术前,空白对照组患者给予禁食、静脉营养支持、抑酸等常规治疗;在此基础上,其余4个药物组患者均于手术前6 h开始按照说明书进行预防用药。比较5组患者ERCP术后高淀粉酶血症和胰腺炎的发生率,术后3、24、48 h视觉模拟法(VAS)评分,以及不良反应发生情况。采用成本-效果分析法评定各组治疗方案的经济性。结果:与空白对照组比较,生长抑素组、乌司他丁组、奥曲肽组和加贝酯组患者的住院时间显著缩短,高淀粉酶血症和胰腺炎的发生率显著降低,术后3、24、48 h的VAS评分显著降低,差异均有统计学意义(P<0.05)。4个药物组之间比较,上述考察指标均无明显差异,不良反应发生率均较低且差异无统计学意义(P>0.05)。生长抑素组的成本-效果比最低,最具有成本效果优势;增量成本-效果比及敏感度分析结果也证实此结果。结论:生长抑素、乌司他丁、奥曲肽和加贝酯均能有效预防ERCP术后高淀粉酶血症和胰腺炎的发生,减轻患者疼痛,并具有较高的安全性。其中,生长抑素能以最低成本取得最佳疗效,为抑制ERCP术后高淀粉酶血症和胰腺炎的最合理方案。OBJECTIVE： To evaluate the economics of somatostatin, ulinastatin, octreotide and gabexate preventing hyperamy- lasemia and pancreatitis after endoscopic retrograde cholangiopancreatography （ERCP）. METHODS： Medical records of 316 cho- ledocholithiasis patients underwent ERCP were selected from our hospital during Jul. 2008-Apr. 2016, and then divided into blank control group （58 cases）, somatostatin group （64 cases）, ulinastatin group （65 cases）, octreotide group （68 cases） and gabexate group （61 cases） according to the use of protease inhibitor. Before ERCP, blank control group received routine treatment as fasting, parenteral nutrition support, acid suppression, etc. Based on it, other 4 drug groups received prophylactic drug use according to package inserts 6 h before ERCE The incidence of hyperamylasemia and pancreatitis after ERCP, VAS scores 3, 24, 48 h after surgery and the occurrence of ADR were compared among 5 groups. The cost-effectiveness analysis was used to evaluate the economics of therapy plans in each group. RESULTS： Compared with blank control group, hospitalization time of somatostatin group, ulinastatin group, octreotide group and gabexate group were shortened significantly; the incidence of hyperamylasemia and pancreatitis were significantly decreased; VAS score 3, 24, 48 h after surgery were significantly decreased, with statistical significance （P〈0.05）. Compared among 4 groups, above indexes had no significant difference, and the incidence of ADR was in low level and had no statistical significance （P〉0.05）. The cost-effectiveness ratio of somatostatin group was the lowest and has cost-effectiveness advantage. The results were supported by incremental cost-effectiveness and sensitivity analysis. CONCLUSIONS： Somatostatin, ulinastatin, octreotide and gabexate can significantly prevent the occurrence of hyperamylasemia and pancreatitis after ER- CP, and relieve pain with good safety. Somatostatin can achieve the best therapeutic efficacy at the low

关 键 词：内镜逆行胰胆管造影术 胆总管结石 生长抑素 乌司他丁 奥曲肽 加贝酯 高淀粉酶血症 胰腺炎 成本-效果分析 药物经济学 

分 类 号：R956[医药卫生—药学] R576