吲哚美辛预防ERCP术后高淀粉酶血症及减轻疼痛程度的最佳给药时间  

Optimal administration time of indomethacin in preventing hyperamylasemia after ERCP and reducing pain degree

作　　者：黄帅[1] 梁珊珊[1] Huang Shuai;Liang Shanshan(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jidotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《中华胰腺病杂志》2020年第3期207-210,共4页Chinese Journal of Pancreatology

摘　　要：目的观察不同时间给予吲哚美辛肛栓对ERCP术后血淀粉酶升高、胰腺炎发生及疼痛程度的影响,探讨最佳给药时间。方法选取2018年5月至2019年5月间上海交通大学医学院附属新华医院普外科收治的240例拟行ERCP治疗胆管疾病患者,按数字表法随机分为6组,每组40例,分别于ERCP术前120、60、30 min及术后30、60、120 min给予直肠内吲哚美辛100 mg纳肛。比较各组间ERCP术后高淀粉酶血症、ERCP术后胰腺炎(PEP)发生率及术后疼痛程度的差异。结果术前给药组患者的术后24 h血淀粉酶升高倍数、高淀粉酶血症发生率、PEP发生率及术后3、24 h的疼痛评分均显著低于术后给药组[(4.2±1.9)倍比(4.7±2.1)倍,36.7%比46.7%,19.2%比24.2%,(5.9±2.1)分比(6.4±1.4)分,(3.8±1.7)分比(4.3±1.4)分,P值均<0.05],其中术前30 min给药组患者术后血淀粉酶升高倍数最小[(2.5±1.2)倍],术后高淀粉酶血症及PEP发生率最低[27.5%(11/40),12.5%(5/40)],术后疼痛评分最低[(3.0±1.2)分]。结论吲哚美辛肛栓可降低ERCP术后高淀粉酶血症及PEP发生率、减轻患者术后疼痛的程度,术前30 min给药可获得最佳的预防效果。Objective To observe tlir effects of different indomethacin anal suppository administration time on increased seium amylase,pancreatitis onset and the degree of pain after ERCP,and explore the optimal administriition time.Methods A total of 240 patients with cholangiopathy who were adniilted and planned to be treated by ERCP in Department of General Surgery of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2018 to May 2019 were randomly divided into 6 groups using random number method with 40 patients in each group,who were given 100mg intrareclal indomethacin at 120 min,60 min,30 min before ERCP and 30min,60 min,120 min alter ERCP.The incidence of posl-ERdP hyprramylasrmia,post-ERCP pancreatitis(PEP)and the degree of postoperative pain were compared among different groups.Results The increased times of blood amylase level and the incidence of hyperamylasemia and l)EP at 24 hour,and postoperative 3 h and 24 h pain scores in prroperative medication group were significantly lower than those in postoperative medication group[(4.2±1.9)us(4.7±2.1),36.7%vs 46.7%,19.2%us 24.2%,(5.9±2.1)r.s-(6.4±1.4)and(3.8±1.7)us(4.3±1.4)score,all<0.05),and the amylase increased times(2.5±1.2),the incidence of hyperamylasemia and PEP[(27.5%(11/40)vs 12.5%(5/40),and postoperative pain score(3.0±1.2)were the least in preoprrative 30 min medication group.Conclusions Indomethacin anal suppositoi-y can reduce the incidrncr of postoperative hyperamylasemia and PEP and mitigate the pain degree after ERCP,and indomethacin given 30 minutes before ERCP may obtain the best preventive effect.

关 键 词：胰胆管造影术 内窥镜逆行 胰腺炎 吲哚美辛 疼痛 

分 类 号：R576[医药卫生—消化系统]