生长抑素在预防胆总管结石患者ERCP术后胰腺炎和高淀粉酶血症中的临床作用

目的探讨生长抑素对胆总管结石患者ERCP术后胰腺炎（PEP）和高淀粉血症（hyperamylasemia）的预防作用。方法将80例行ERCP的胆总管结石患者随机分为生长抑素组（n=41）和对照组（n=39）,生长抑素组于术后30 min给予生理盐水50 mL＋生长抑素6 mg静脉泵入,4 mL/h,持续24 h;对照组泵入同等量的液体,但无生长抑素加入,分别检测两组患者术前、术后4 h、术后24 h血淀粉酶值,并观察有无胰腺炎发生。结果生长抑素组术前、术后24 h淀粉酶值与对照组比较差异无统计学意义（P=0.292〉0.05、P=0.9870.05）,术后4 h生长抑素组淀粉酶显著低于对照组P=0.002〈0.05）,术后4 h、24 h生长抑素组高淀粉酶血症发生率比对照组显著降低（χ2=5.61,P〈0.05;χ2=6.25,P〈0.05）,术后24 h内生长抑素组胰腺炎的发生率比对照组明显减少（χ2=4.35,P〈0.05）,生长抑素组无重症胰腺炎发生,而对照组有1例。结论生长抑素可有效预防胆总管结石患者ERCP术后胰腺炎及高淀粉酶血症的发生。

The clinical effect of somatostatin on pancreatitis and hyperamylasemia after ERCP for patients with common bile duct calculi

Objective To explore the prophylactic effect of somatostatin on pancreatitis and hyperamylasemia after ERCP.Methods Eighty patients who were scheduled for ERCP were randomly divided into somatostatin group（n = 41） and control group（n = 39）.Somatostatin group was given conventional somatostatin of 6 mg dissolved in 50 mL of physiological saline at 30 minutes after the procedure,intravenous infusion,4 mL/hour,for 24 hours.Control group was given 50 mL of saline solution alone within 24 hours.Serum levels of amylase were detected before and 4 and 24 hours after the procedure.The clinical manifestations of pancreatitis were observed simultaneously.Results Serum lev els of amylase was not statistical significance before and 24 hours after ERCP in the somatostatin group than in the control group（P = 0.292 0.05,P = 0.9870.05）.Serum levels of amylase was markedly lower in the somatostatin group than in the control group 4 h post ERCP（P=0.0020.05）.Hyperamylamia occurred markedly lower in the somatostatin group than in the control group 4 hours and 24 hours after ERCP（χ2=5.61,P0.05;χ2=6.25,P0.05）.The incidence of acute pancreatitis occurred markedly lower 24 hours after ERCP in the somatostatin group than that in the control group（χ2=4.35,P0.05）.The incidence of severe pancreatitis was 0 in somatostatin group and 1 case in control group.Conclusion Somatostatin can effectively prevent hyperanylasemia and acute pancreatitis after ERCP.