吲哚美辛联合乳酸林格液在内镜下逆行胰胆管造影术后胰腺炎高危患者中的应用  

Application of indomethacin combined with lactate Ringer’s solution in high-risk patients with post-ERCP pancreatitis

作　　者：措羊 陶海明 白化千 CUO Yang;TAO Hai-ming;BAI Hua-qian(Department of the Second General Surgery,Qinghai Communications Hospital,810008 Xining,China)

机构地区：[1]青海省交通医院普外二科,青海西宁810008

出　　处：《临床消化病杂志》2020年第5期323-328,共6页Chinese Journal of Clinical Gastroenterology

基　　金：青海省科技计划项目(No:2016-ZJ-703)。

摘　　要：[目的]探讨吲哚美辛联合乳酸林格液在内镜下逆行胰胆管造影术(ERCP)术后胰腺炎(PEP)高危患者中的应用效果。[方法]纳入拟行ERCP且存在PEP高危因素的患者240例,随机分为吲哚美辛+乳酸林格液组(IND+LR组)和吲哚美辛+0.9%氯化钠溶液组(IND+NS组),每组120例。IND+LR组、IND+NS组在给予吲哚美辛(100 mg,纳肛,术前30 min)相同干预方式基础上,分别再接受大剂量乳酸林格液、0.9%氯化钠溶液水化治疗(前1 h内20 ml/kg,随后以3 ml/kg^(-1)·h^(-1)速度维持8 h,静脉输注)。检测2组术前和术后24 h血C-反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平,观察2组PEP总体发生率、严重度分布、中重度急性胰腺炎(AP)发生率、高淀粉酶血症发生率和液体超负荷发生情况。[结果]IND+NS组与IND+LR组PEP总体发生率、中重度AP发生率比较均差异有统计学意义(P<0.05);IND+LR组高淀粉酶血症发生率虽较IND+NS组降低,但2组比较差异无统计学意义(P>0.05)。ERCP术后24 h,IND+LR组血CRP、IL-6和TNF-α水平显著低于IND+NS组,差异有统计学意义(P<0.05)。2组PEP严重度分布比例差异无统计学意义(P>0.05)。2组均未发生药物相关不良反应和液体超负荷。[结论]吲哚美辛和乳酸林格液联合应用有效提高抑制炎症作用,能增强PEP高危风险患者的预防效果。[Objective]To investigate the effect of indomethacin combined with lactate Ringer’s solution in high-risk patients with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis.[Methods]A series of 240 patients with high risk factors of post-ERCP pancreatitis(PEP)were prospectively enrolled in our hospital from January 2018 to March 2019.They were randomly divided into indomethacin+lactate Ringer’s solution group(IND+LR group,n=120)and indomethacin+normal saline group(IND+NS group,n=120).The IND+LR group and IND+NS group were treated with high-dose lactate Ringer’s solution or normal saline hydration(20 ml/kg in the first hour,then maintained for 8 hours at a rate of 3 ml·kg-1·h-1,intravenous infusion)on the basis of the same intervention with indomethacin(100 mg,transrectal,30 minutes before operation).Blood levels of C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured before and 24 hours after ERCP in the two groups.The incidence of total PEP and severity distribution,the incidence of moderate or severe acute pancreatitis(AP),the incidence of hyperamylasemia and the occurrence of fluid overload in the two groups were observed.[Results]Compared with IND+NS group,the incidence of total PEP in IND+LR group was significantly lower,the incidence of moderate or severe acute pancreatitis(AP)was significantly lower,and the incidence of hyperamylasemia was significantly lower(P<0.05).At 24 hours after ERCP,the levels of CRP,IL-6 and TNF-αin IND+LR group were significantly lower than those in IND+NS group(P<0.05).There was no significant difference in severity distribution of PEP between the two groups(P>0.05).No drug-related adverse reactions and fluid overload occurred in both groups.[Conclusion]The combination of indomethacin and lactate Ringer’s solution can effectively improve the anti-inflammatory effect and enhance the preventive effect of high-risk patients with PEP.

关 键 词：胰腺炎 内镜下逆行胰胆管造影术 吲哚美辛 乳酸林格液 

分 类 号：R576[医药卫生—消化系统]