奥曲肽对高/低风险患者ERCP术后生活质量的影响及其胰腺炎的预防  

Impacts of octreotide on post-ERCP quality of life in high-/low-risk patients and its prevention against post-ERCP pancreatitis

作　　者：和庆章 王桂良 龚敏 邱萍 徐林芳 文剑波[1] 肖献忠[2] 谭斯品[2] HE Qingzhang;WANG Guiliang;GONG Min;QIU Ping;XU Linfang;WEN Jianbo;XIAO Xianzhong;TAN Sipin(Department of Gastroenterology,Pingxiang People's Hospital Affiliated to Gannan Medical University,Pingxiang337000,China;Xiangya Hospital Central South University,Changshang410078,China)

机构地区：[1]赣南医学院附属萍乡医院消化内科,江西萍乡337000 [2]中南大学湘雅医学院,湖南长沙410078

出　　处：《中国现代医生》2020年第7期31-36,共6页China Modern Doctor

基　　金：国家自然科学基金项目(81360080)。

摘　　要：目的探讨奥曲肽对高/低风险患者内镜逆行性胰胆管造影术(Endoscopic retrograde cholangiopancreatography,ERCP)术后生活质量的影响及其胰腺炎(post-ERCP pancreatitis,PEP)的预防作用。方法回顾分析我院2011年1月~2019年3月行ERCP治疗的患者1184例,根据发生PEP的风险性,将患者分为PEP高风险和低风险组,两组再根据是否使用奥曲肽的基础上再分为奥曲肽亚组和空白对照亚组。分析四组ERCP术后住院成本、ERCP后住院天数、高淀粉酶血症、PEP、术后6 h、12 h和24 h视觉模拟评分(Visual analogue scale,VAS)、肿瘤坏死因子α(Tumour necrosis Factor-α,TNF-α)、白细胞介素6(Interleukin-6,IL-6),IL-8浓度、并发症和副反应的发生率。结果高风险组中,与空白对照组比较,奥曲肽组住院成本、住院时间,奥曲肽组高淀粉酶血发生率、PEP发生率显著性减少,术后6 h、12 h、24 h各时间点VAS疼痛评分显著性降低,术后6 h、12 h、24 h时间点TNF-α、IL-6和IL-8的浓度显著性降低,同组内VAS、6 h、12 h、24 h TNF-α、IL-6和IL-8的浓度比较,均依次显著性降低,并发症的发生率显著性降低,副反应发生率显著性升高。在低风险组中,与空白对照组比较,奥曲肽组住院成本、住院时间、高淀粉酶血发生率、PEP发生率差异无统计学意义,术后6 h、12 h、24 h VAS疼痛评分显著性降低,术后6 h、12 h、24 h时间点TNF-α、IL-6和IL-8的浓度显著性降低,同组内VAS、6 h、12 h、24 h TNF-α、IL-6和IL-8的浓度比较,均依次显著性降低,两组均无并发症发生,副反应发生率显著升高。结论对于PEP高风险患者,奥曲肽可有效减少PEP的发生率,并改善患者术后生活质量;对于PEP低风险组患者,奥曲肽不能减少PEP的发生率,但可改善患者术后生活质量。Objective To investigate impacts of octreotide on quality of life after endoscopic retrograde cholangiopancreatography(ERCP)in high/low-risk patients and its prevention against post-ERCP pancreatitis(PEP).Methods In this retrospective analysis,1,184 patients admitted in our hospital from January 2011 to March 2019 underwent ERCP.They were divided into the high-risk PEP group and the low-risk PEP group according to their risks of PEP onset,and further into the octreotide subgroup and the control subgroup according to whether they received octreotide.Cost of hospital admission,days in hospital after ERCR,incidences of post-ERCP hyperamylasemia and PEP,visual analogue scale(VAS)scores at 6,12 and 24 h after surgery,concentrations of tumour necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-8,incidence rates of complications and side effects in the four subgroups were analyzed.Results In the high-risk PEP group,compared with the control subgroup,cost of hospital admission,length of hospital stay,incidence rates of hyperamylasemia and PEP significantly decreased in the octreotide subgroup.Besides,VAS scores and concentrations of TNF-α,IL-6 and IL-8 significantly decreased at 6,12 and 24 h after surgery in the octreotide subgroup.Intragroup comparisons showed that VAS scores and concentrations of TNF-α,IL-6 and IL-8 progressively decreased at 6,12 and 24 h after surgery,accompanied by significantly reduced incidence rates of complications and increased rates of side effects.In the low-risk PEP group,there were nonsignificant differences in cost of hospital admission,length of hospital stay and incidence rates of hyperamylasemia and PEP between the two subgroups.However,in comparison with the control subgroup,VAS scores at 6 and 12 h after surgery significantly decreased,and concentrations of TNF-α,IL-6 and IL-8 at 6,12 and 24 h after surgery significantly decreased in the octreotide subgroup.Intragroup comparisons showed that both VAS scores and concentrations of TNF-α,IL-6 and IL-8 progressively decreased at 6,1

关 键 词：内镜逆行胰胆管造影 奥曲肽 胰腺炎 预防 

分 类 号：R576.2[医药卫生—消化系统]