吲哚美辛预防老年胆总管结石患者ERCP术后胰腺炎的效果

目的探讨吲哚美辛对老年胆总管结石患者内镜下逆行胰胆管造影(ERCP)术后胰腺炎的预防作用。方法选取该院2013年6月至2014年12月收治的符合入选要求的60例老年胆总管结石患者,随机分为对照组和观察组,每组30例。于术前45 min对照组给予安慰剂栓剂,观察组直肠内给予吲哚美辛栓100 mg,行ERCP术。观察对照组及观察组患者手术前及手术后4、24、48 h血清淀粉酶水平、VAS疼痛评分及胰腺炎、高淀粉酶血症发生率,并进行统计分析。结果观察组手术后4、24、48 h血清淀粉酶水平均与对照组同比降低(P0.05);两组患者术后4、24、48 h VAS疼痛评分均显著高于同组术前(P0.05),且观察组手术后4 h VAS疼痛评分显著低于对照(P0.05);观察组胰腺炎、高淀粉酶血症发生率均显著低于对照组(P0.05)。结论吲哚美辛可有效预防老年胆总管结石患者ERCP术后胰腺炎的发生,减轻疼痛及炎症反应,提高术后恢复。     

吲哚美辛在预防ERCP术后胰腺炎中作用的研究

目的观察直肠应用吲哚美辛对ERCP术后胰腺炎（PEP）及高淀粉酶血症的预防作用。方法将行ERCP检查的168例患者随机分为两组,吲哚美辛组在ERCP术前30 min直肠内给予吲哚美辛栓剂100 mg,对照组在ERCP术前30 min直肠内给予安慰剂栓。ERCP术后观察患者有无腹痛,并于术后12 h做血清及尿淀粉酶测定。结果吲哚美辛组PEP发生率（6.0%）与安慰剂组PEP发生率（10.6%）无显著差异（P=0.28）,但是吲哚美辛组ERCP术后高淀粉酶血症的发生率（18.1%）显著低于安慰剂组（37.6%,P=0.005）。结论直肠应用吲哚美辛可以预防ERCP术后高淀粉酶血症的发生。     

直肠应用吲哚美辛对老年胆总管结石ERCP术后胰腺炎的预防作用

目的 观察直肠应用吲哚美辛对老年胆总管结石内镜下逆行胰胆管造影术（ERCP术）后胰腺炎的预防作用.方法 将68例老年胆总管结石患者随机分为观察组36例和对照组32例,观察组术前30 min加用吲哚美辛100mg肛塞,对照组给予安慰剂栓剂,后两组均行ERCP术,观察术后两组胰腺炎发生率,采用SomogYi法检测两组术前及术后3、24h血清淀粉酶.结果 观察组及对照组术后发生胰腺炎分别为3例（8.3％）、7例（21.9％）,两组比较P＜0.05.与术前比较,两组术后3、24h血清淀粉酶水平升高（P均＜0.05）;与对照组比较,观察组术后3、24h血清淀粉酶水平降低（P均＜0.05）.结论 直肠应用吲哚美辛可有效预防老年胆总管结石ERCP术后胰腺炎的发生.     

吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎和高淀粉酶血症的效果

目的探讨预防性使用吲哚美辛治疗经内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的效果及安全性。方法按既定标准入选接受ERCP诊治患者243例,随机分为吲哚美辛组(81例)、奥曲肽组(78例)和安慰剂组(84例),观察记录各组患者术前、术后3、24 h的血清淀粉酶水平,并评估患者ERCP术后胰腺炎和高淀粉酶血症的发生率。结果三组患者ERCP术前的血清淀粉酶均在正常范围内。吲哚美辛组〔(99.12±44.58)U/L〕和奥曲肽组〔(100.27±43.31)U/L〕患者ERCP术后24 h血清淀粉酶水平均低于对照组〔(195.45±89.67)U/L〕(均P<0.05),但吲哚美辛组和奥曲肽组比较,二者无明显差异。三组患者ERCP术后胰腺炎发生率,吲哚美辛组(4.94%)和奥曲肽组(5.13%)均低于安慰剂组(15.48%)(均P<0.05),但吲哚美辛组与奥曲肽组相比无明显差异。ERCP术后高淀粉酶血症发生率,吲哚美辛组(2.47%)、奥曲肽组(1.28%)均低于安慰剂组(13.61%),差异有或接近显著性意义,而吲哚美辛组和奥曲肽组之间无明显差异。结论 ERCP术前经直肠给予吲哚美辛可有效降低老年ERCP术后PEP和高淀粉酶血症的发生率,并且效果与奥曲肽相比无明显差异,但具有较好的性价比,安全性高。     

吲哚美辛及鼻胆管引流预防内镜下逆行胰胆管造影术后胰腺炎及高淀粉酶血症效果观察

目的探讨预防性吲哚美辛直肠给药及术后鼻胆管引流术(ENBD)对内镜下逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉血症的预防作用及安全性。方法行ERCP诊治的患者152例,随机分为吲哚美辛组(n=49)、ENBD组(n=50)和安慰剂组(n=53)。观察各组术后2、6、24 h血清淀粉酶水平,对比PEP、高淀粉酶血症的发生率及预后。结果吲哚美辛组与ENBD组的PEP及高淀粉酶血症的发生率低于安慰剂组(P均<0.05)。血清淀粉酶变化,吲哚美辛组和ENBD组术后2、6 h较安慰剂组低(P均<0.05);但术后24 h血清淀粉酶水平组间比较差异无统计学意义(P均>0.05)。吲哚美辛组和ENBD组胰腺炎患者腹部症状体征消失时间及平均住院时间较安慰剂组明显缩短(P均<0.05)。结论吲哚美辛、ENBD均可有效预防ERCP术后PEP及高淀粉酶血症的发生,同时吲哚美辛干预方法更为经济。     

吲哚美辛预防经内镜逆行胰胆管造影术后胰腺炎使用时机探讨

目的 探讨吲哚美辛预防经内镜逆行胰胆管造影术（ERCP）后胰腺炎的最佳使用时机。 方法 采用随机对照法,将纳入患者分为术前组和术后组,分别在ERCP术前30 min、术后30 min内予吲哚美辛100 mg直肠内给药。测定患者术前、术后4 h、术后24 h血清淀粉酶、脂肪酶水平,评估术后急性胰腺炎、高淀粉酶血症、消化道出血、穿孔等并发症发生情况。 结果 2014年6月至2017年6月间共入组患者340例。其中术前组163例,发生急性胰腺炎11例（6.75％）,高淀粉酶血症32例（19.63％）;术后组177例,发生急性胰腺炎25例（14.12％）,高淀粉酶血症55例（31.07％）。术前组急性胰腺炎、高淀粉酶血症发生率较术后组低（P=0.027,P=0.016）。 结论 术前使用吲哚美辛较术后使用可以更好地减少ERCP术后胰腺炎的发生,并且不增加其他并发症的发生率。     

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

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...     

直肠非甾体类抗炎药对ERCP术后胰腺炎的预防作用

目的观察直肠非甾体类抗炎药（NSAIDs）对ERCP术后高淀粉酶血症及胰腺炎的预防及治疗作用。方法将符合标准的患者随机分为2组，每组30例。预防组在ERCP术前30min肌注地西泮及山莨菪碱各10mg，同时给予引哚美辛栓100mg塞肛；对照组在ERCP术前30min肌注地西泮及山莨菪碱各10mg。ERCP术前及术后6h、24h测定血清淀粉酶水平。结果比较预防组和对照组ERCP术后6h、24h血清淀粉酶的活性，发现ERCP术后6h两组间血清淀粉酶分别为（367．5±268．7）U／L、（1034．2±713．5）U／L，术后24h两组间血清淀粉酶分别为（324．9±142．3）U／L、（826．8±395．7）U／L，两组问差异均有统计学意义（P〈0．05）。结论直肠NSAIDs具有预防ERCP术后高淀粉酶血症及胰腺炎的作用。     

直肠非甾体类抗炎药对ERCP术后胰腺炎的预防作用

Objective To investigate the preventive and therapeutic effects of nonsteroidal anti-inflammatory drugs ( NSAIDs) via rectum for hyperamylasemia and pancreatitis after ERCP (endoscopic retrograde cholangiopancreatography).Methods Sixty patients who underwent ERCP for various reasons were randomly divided into preventive and control groups.In addition to routine diazepam (10 mg) and anisodamine (10 mg) given intramuscularly in both groups before ERCP, 100 mg of indometacin suppositories was administered by rectum in preventive group.Serum amylase level was measured before and 6 hours and 24 hours after the procedure.Results Serum amylase levels at 6 hours after ERCP in preventive and control groups were (367.5 ± 268.7 ) U/L and (1034.2 ± 713.5 ) U/L, respectively ( P < 0.05 ), which were (324.9±142.3)U/L and (826.8 ±395.7)U/L, respectively, at 24 hours after ERCP (P<0.05).Conclusion Rectal use of NSAIDs can prevent hyperamylasemia and acute pancreatitis induced by ERCP.     

直肠非甾体类抗炎药对ERCP术后胰腺炎的预防作用

Objective To investigate the preventive and therapeutic effects of nonsteroidal anti-inflammatory drugs ( NSAIDs) via rectum for hyperamylasemia and pancreatitis after ERCP (endoscopic retrograde cholangiopancreatography).Methods Sixty patients who underwent ERCP for various reasons were randomly divided into preventive and control groups.In addition to routine diazepam (10 mg) and anisodamine (10 mg) given intramuscularly in both groups before ERCP, 100 mg of indometacin suppositories was administered by rectum in preventive group.Serum amylase level was measured before and 6 hours and 24 hours after the procedure.Results Serum amylase levels at 6 hours after ERCP in preventive and control groups were (367.5 ± 268.7 ) U/L and (1034.2 ± 713.5 ) U/L, respectively ( P < 0.05 ), which were (324.9±142.3)U/L and (826.8 ±395.7)U/L, respectively, at 24 hours after ERCP (P<0.05).Conclusion Rectal use of NSAIDs can prevent hyperamylasemia and acute pancreatitis induced by ERCP.     

Combined rectal indomethacin and intravenous saline hydration in post-ERCP pancreatitis prophylaxis

Background and study aimAcute pancreatitis (AP) is a potentially life-threatening complication of endoscopic retrograde cholangiopancreatography (ERCP). There is a lack of effective measures to prevent post-ERCP pancreatitis (PEP), except NSAIDs. Aggressive hydration for AP can be considered, given the frequency of hemoconcentration, hypovolemia, and hypoperfusion in pancreatitis. We aimed to clarify the clinical utility of combined indomethacin and saline hydration for preventing PEP.Patients and methodIn this cross-sectional study, 120 patients undergoing ERCP for the first time at the Gastrointestinal Endoscopy Unit and Liver Unit Kasralainy (GIELUKA) were enrolled and then randomly allocated into two groups: indomethacin and indomethacin-hydration groups. Intravenous (IV) saline was given to the latter at a rate of 10 ml/kg/h after the ERCP for 2 h.ResultsThe age of the studied patients was 43.8 ± 14.9 years, with 55% of them being female. The patient-related risk factors for PEP were older age (p = 0.039), higher pre-ERCP urea level (p = 0.032), and less choledocholithiasis (p = 0.028). The patients with PEP had a higher frequency of biliary cannulation attempts (p = 0.004) and accidental pancreatic duct cannulation (p = 0.003), required a longer cannulation time (p = 0.021), had undergone precut knife and transpancreatic sphincterotomy at a higher rate (p = 0.032; and p = 0.001, respectively), and had a significantly longer procedure time (p = 0.006).PEP occurred in only five patients in the indomethacin group, while it did not occur in the indomethacin-hydration group (8% vs. 0%, p = 0.022). Serum amylase and lipase elevation 2 h after ERCP were predictors of PEP. However, serum amylase only was significantly lower 2 h post-ERCP in the indomethacin-hydration group than in the indomethacin group (p = 0.045). Moreover, abdominal pain and vomiting on the first day of ERCP were good predictors of PEP.ConclusionAggressive IV saline hydration with rectal indomethacin can more effectively prevent PEP than indomethacin alone.     

Role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis:a meta-analysis

BACKGROUND:The role of prophylactic nonsteroidal anti- inflammatory drugs(NSAIDs)for reduction of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP)is debated.We performed a meta-analysis of all published randomized controlled trials to evaluate the efficacy of NSAIDs in the prevention of post-ERCP pancreatitis. DATA SOURCES:Searches were conducted in the databases PubMed,EMBASE and the Cochrane Library. Six randomized clinical trials that fulfilled the inclusion criteria and addressed...     

Pre-endoscopic retrograde cholangiopancreatography (ERCP) administration of rectal indomethacin in unselected patients to reduce post-ERCP pancreatitis: A systematic review and meta-analysis

Introduction

Previous studies have reported that peri-procedural administration of rectal indomethacin reduces the risk of pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Based on these studies, gastrointestinal (GI) societies recommend prophylactic rectal indomethacin for all patients undergoing ERCP. However, recent studies have reported contradictory results. The aim of this study was to perform a systematic review and meta-analysis to estimate the pooled relative risk (RR) of post-ERCP pancreatitis (PEP) in unselected patients who received rectal indomethacin before the ERCP (pre-ERCP) compared to patients who received pre-ERCP rectal placebo.

Methods

We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through September 1, 2017) to identify randomized control trials (RCTs) investigating the role of pre-ERCP rectal indomethacin in reducing the risk of PEP in unselected patients undergoing ERCP. The databases included Ovid, Medline, In-Process, and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science. We calculated a pooled estimate of the RR of PEP in patients who received pre-ERCP rectal indomethacin compared to patients who received pre-ERCP rectal placebo. The meta-analysis was performed using the random effects model.

Results

Six RCTs with a total of 2229 patients were included in the final meta-analysis. There were 1143 patients in the rectal indomethacin group and 1086 patients in the rectal placebo group. There were 71 events of PEP in the rectal indomethacin group and 114 events of PEP in the rectal placebo group. Pre-ERCP administration of rectal indomethacin significantly reduced the risk of PEP compared to pre-ERCP rectal placebo (RR 0.60, 95% CI, 0.45–0.80; p<0.0001). There was no heterogeneity between the studies (I² =?0).

Conclusion

The results of this meta-analysis support the routine pre-ERCP administration of rectal indomethacin in unselected patients to prevent PEP.

     

内镜逆行胰胆管造影术后胰腺炎的药物预防

内镜逆行胰胆管造影术(endoscop ic retrograde cholangiopancreatography,ERCP)已发展成为肝胆胰疾病的重要诊治手段,ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)是ERCP术后最常见、最严重的并发症之一,常导致住院日的延长,费用的增加,甚至危及患者的生命。本文对PEP的的定义、分级及药物预防方面的最新研究进展做一综述。     

Meta-analysis of prophylactic corticosteroid use in post-ERCP pancreatitis

Background

Genetic factors as well as environmental factors are important in the development of NAFLD and in this study we investigated associations between polymorphisms of peroxisome proliferators-activated receptor γ coactivator 1α polymorphism (PPARGC1A) and NAFLD.

Aims

We recruited 115 patients with biopsy-proven NAFLD, 65 with NASH and 50 with simple steatosis, and 441 healthy control subjects and investigated 15 SNPs of PPARGC1A.

Results

SNP rs2290602 had the lowest p value in the dominant mode (p = 0.00095), and the odds ratio for NAFLD (95% CI) was 2.73 (1.48 – 5.06). rs2290602 was significantly associated with NAFLD even when the most conservative Bonferroni's correction was applied (p = 0.0143). The frequency of the T allele of rs2290602 was significantly higher in the NASH patients than in the control subjects (p = 0.00093, allele frequency mode), and its frequency in the NASH patients tended to be higher than in the simple steatosis patients (p = 0.09). The results of the real-time RT-PCR study showed that intrahepatic mRNA expression of PPARGC1A was lower in the TT group than in the GG or GT group at SNP rs2290602 (p = 0.0454).

Conclusion

This is the first study to demonstrate a significant association between genetic variations in PPARGC1A and NAFLD. This finding suggested that PPARGC1A polymorphism and lower expression of PPARGC1A mRNA in the liver are an important genetic contribution to etiology of NAFLD.