静脉应用选择性非甾体类抗炎药预防经内镜逆行胰胆管造影术联合乳头括约肌切开术术后急性胰腺炎的疗效  

The efficacy of intravenous application of selective non⁃steroidal anti⁃inflammatory drugs for preventing post⁃ERCP pancreatitis after endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy

作　　者：宛星宇 毛屏[2] 范中宝[2] 柳青峰 WAN Xingyu;MAO Ping;FAN Zhongbao;LIU Qingfeng(The Graduate School of Dalian Medical University,Dalian 116000,China;不详)

机构地区：[1]大连医科大学研究生院,辽宁大连116000 [2]中国医科大学人民医院肝胆外科,沈阳110000 [3]辽宁省金秋医院普外科,沈阳110000

出　　处：《实用医学杂志》2021年第24期3158-3162,共5页The Journal of Practical Medicine

基　　金：辽宁省科学技术计划项目(编号:20180550481)。

摘　　要：目的探讨静脉应用选择性非甾体类抗炎药(NSAIDS)预防经内镜逆行胰胆管造影术(ERCP)联合乳头括约肌切开术(EST)术后发生急性胰腺炎(PEP)的临床疗效。方法回顾分析2019年1月1日至2021年1月1日接受ERCP+EST治疗的95例胆总管结石患者的临床资料。观察组术后静脉应用选择性NSAIDS治疗,对照组术后常规药物治疗。根据相关危险因素,将总人群分为高风险人群亚组和平均风险人群亚组,分为观察组a(n=31)和对照组a(n=27)、观察组b(n=15)和对照组b(n=22)。比较两组患者临床疗效和安全性。结果高风险人群亚组:观察组PEP发生率降低、腹痛持续时间减少、腹胀持续时间减少、恢复进食时间减少、术后住院时间减少、VAS疼痛评分降低、QoR⁃15评分升高、术后血淀粉酶(AMS)及血脂肪酶(LPS)降低(P<0.05)。平均风险人群亚组:观察组术后丙氨酸转氨酶(ALT)升高、呕吐次数增多、恢复进食时间减少(P<0.05)。结论针对高风险人群,静脉应用选择性NSAIDS可以有效预防PEP的发生、改善预后、提高康复质量;但针对平均风险人群,NSAIDS对于PEP的发生、手术预后及术后康复质量无明显改善,且易导致患者出现消化系统症状及一定程度上的肝损伤。Objective To explore the efficacy of intravenous application of selective non⁃steroidal anti⁃inflammatory drugs(NSAIDs)for preventing post⁃ERCP pancreatitis(PEP)after endoscopic retrograde cholangio⁃pancreatography(ERCP)combined with endoscopic sphincterotomy(EST).Methods The clinical data on 95 patients with choledocholithiasis who had undergone ERCP plus EST from January 1,2019 to January 1,2021 were retrospectively analyzed.After surgical treatment,the study group received selective NSAIDs,while the control group was treated with conventional drugs.According to the relevant risk factors,the total population was divided into a high⁃risk population subgroup and an average risk population subgroup.They were then subdivided into study group a(n=31),control group a(n=27),study group b(n=15),and control group b(n=22).The clinical efficacy and safety were compared between the two groups.Results The high⁃risk population:in the study group,the incidence of PEP and the duration of abdominal pain and distension decreased,the time to resum⁃ing eating and the postoperative hospital stay were shortened,the VAS pain score decreased,the QoR⁃15 score increased,and the levels of postoperative AMS and LPS decreased(P<0.05).The average risk population:post⁃operative ALT levels in the study group and the frequency of vomiting increased,the time to resuming eating was shortened(P<0.05).Conclusions For the high⁃risk population,intravenous application of selective NSAIDs can prevent the occurrence of PEP,improve prognosis and quality of rehabilitation.However,for the average risk population,NSAIDs do not markedly reduce the occurrence of PEP and do not evidently improve prognosis and quality of postoperative rehabilitation;and it is easy to cause the patients to develop digestive system symptoms and a certain degree of liver damage.

关 键 词：非甾体类抗炎药 急性胰腺炎 手术并发症 高风险人群 经内镜逆行胰胆管造影术 乳头括约肌切开术 

分 类 号：R657.4[医药卫生—外科学]