吲哚美辛、生长抑素单用或联用使用的选择适应征及其对高风险ERCP患者术后胰腺炎的预防作用  

Selective indications of indomethacin and somatostatin,alone or in combination,and their preventive effects in patients at high risk for post-ERCP pancreatitis

作　　者：吴灶璇 王桂良 邱萍 龚敏 李兴 文剑波 Zao-Xuan Wu;Gui-Liang Wang;Ping Qiu;Min Gong;Xing Li;Jian-Bo Wen(Department of Gastroenterology,Southern Medical University Affiliated Pingxiang Hospital,Pingxiang 337000,Jiangxi Province,China)

机构地区：[1]南方医科大学附属萍乡医院消化内科,江西省萍乡市337000

出　　处：《世界华人消化杂志》2021年第21期1222-1229,共8页World Chinese Journal of Digestology

摘　　要：背景内镜逆行性胰胆管造影(endoscopic retrograde cholan-giopancreatography,ERCP)术是一项广泛且重要的诊治胆道及其胰腺微创技术,但部分患者会在术后出现胰腺炎(post-ERCP pancreatitis,PEP).生长抑素和吲哚美辛预防PEP的经典药物,学者们对生长抑素、吲哚美辛单用或联用仍存在争议.目的探讨吲哚美辛、生长抑素单用或联用使用的选择适应征及其对高风险ERCP患者PEP的预防作用.方法前瞻性分析2017-01/2020-12我院行高风险ERCP治疗的患者729例,按析因设计随机分为4组:空白组;吲哚美辛组;生长抑素组;吲哚美辛+生长抑素组.分析4组ERCP术后高淀粉酶血症、PEP、术后6 h、12 h、24 h VAS疼痛评分、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-8浓度和副反应发生率.结果与空白对照组比较,吲哚美辛组PEP发生率、住院成本和住院时间差异无统计学意义,高淀粉酶血症发生率和术后6 h内VAS疼痛评分显著性降低、术后TNF-α、IL-6和IL-8浓度均显著性降低.与空白对照组和吲哚美辛组比较,生长抑素组住院成本、住院时间、高淀粉酶血症发生率、PEP发生率、术后6 h、12 h、24 h各时间点VAS疼痛评分及术后TNF-α、IL-6和IL-8浓度均显著性降低.与吲哚美辛组比较,吲哚美辛+生长抑素组住院成本、住院时间、高淀粉酶血发生率、PEP发生率、术后6 h、12 h、24 h时间点VAS疼痛评分显著性降低、术后TNF-α、IL-6和IL-8浓度均显著性降低.与生长抑素组比较,吲哚美辛+生长抑素组PEP发生率、住院成本和住院时间差异无统计学意义,但高血淀粉酶发生率和术后6 h内VAS疼痛评分、TNF-α、IL-6和IL-8浓度均显著性降低,而术后12 h至24 hVAS、TNF-α、IL-6和IL-8浓度比较差异无统计学意义.结论对于高风险ERCP患者,吲哚美辛能降低术后高淀粉酶血症发生率,改善短时间内的患者生活质量,适合于ERCP操作过程较简单、时间较短、预计术BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is a widely used minimally invasive technique for the diagnosis and treatment of biliary and pancreatic disorders.However,some patients may suffer post-ERCP pancreatitis(PEP).Somatostatin and indomethacin are the classical drugs for the prevention of PEP.There is still controversy over the use of somatostatin and indomethacin,alone or in combination,in this context.AIM To investigate the selective indications of indomethacin and somatostatin,alone or in combination,and their preventive effects in patients at high risk for PEP.METHODS A prospective analysis was performed on 729 patients at high risk for PEP at our hospital from January 2017 to December 2020.They were randomly divided into four groups according to factorial design:Placebo group,indomethacin group,somatostatin group,and indomethacin+somatostatin group.Hyperamylasemia,PEP,visual analogue scale(VAS)score,tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),and IL-8 concentrations,and the incidence of side effects were compared among the four groups.RESULTS Compared with the placebo group,the incidence of PEP,hospitalization cost,and length of hospital stay showed no significant difference,but the incidence of hyperamylasemia,VAS score within 6 h after operation,and the TNF-α,IL-6 and IL-8 concentrations significantly decreased in the indomethacin group.Compared with the placebo group or indomethacin group,hospitalization cost,hospitalization time,the incidence of hyperamylasemia,the incidence of PEP,VAS score at 6 h,12 h,and 24 h after operation,and the TNF-α,IL-6,and IL-8 concentrations after operation significantly decreased in the somatostatin group.Compared with the indomethacin+somatostatin group,the cost of hospitalization,length of hospitalization,incidence of hyperamylase blood,incidence of PEP,VAS score at 6 h,12 h and 24 h after operation,and the TNF-α,IL-6 and IL-8 concentrations after operation significantly decreased in the indomethacin+somatostatin group.Compared with t

关 键 词：内镜逆行性胰胆管造影 吲哚美辛 生长抑素 术后胰腺炎 

分 类 号：R576[医药卫生—消化系统]