吲哚美辛对ERCP术后高淀粉酶血症及胰腺炎的预防作用

目的观察常规直肠应用吲哚美辛栓剂对内镜下逆行胰胆管造影术(endoscopic rectrograde cholangiopancreatography,ERCP)术后高淀粉酶血症、胰腺炎的预防作用。方法回顾性分析2009年1月至2014年12月,池州市人民医院消化内镜中心行ERCP治疗的166例临床患者资料,其中术前预防性使用吲哚美辛栓纳肛的病例94例,未使用吲哚美辛72例,比较两组ERCP术前、术后3 h、术后24 h血清淀粉酶水平及术后高淀粉酶血症、胰腺炎的发生率。结果 2组患者术前血淀粉酶无统计学差异(78.0±6.9 vs 87.8±7.8,P0.05),但吲哚美辛组术后3 h血淀粉酶水平显著低于对照组(175.6±67.7 vs438.6±77.4,P0.01),24 h血淀粉酶也低于对照组(227.8±37.3 vs 239.8±38.1,F=19.93,P0.01)。吲哚美辛纳肛组ERCP术后高淀粉酶血症发生率低于对照组(3.2%vs 5.6%,P0.01),吲哚美辛纳肛组ERCP术后胰腺炎发生率也低于对照组(7.4%vs 12.5%,P0.01)。结论 ERCP术前使用吲哚美辛可以预防ERCP术后高淀粉酶血症及术后急性胰腺炎的发生,可以作为常规预防手段使用。

Preventive effect of indomethacin intrarectal application on pancreatitis and hyperamvlasemia of post-ERCP patients

Objective To investigate the preventive effect of intrarectal indomethacin application on hyperamvlasemia and postERCP pancreatitis in ERCP patients.Method The clinical data of 166 cases who underwent ERCP from January 2009 to December 2014 in the Digestive Endoscopy Center of Chizhou City Peoples Hospital were analized retrospectively.94 cases were rectally administrated with indomethacin before operation and other 72 cases were not given indomethacin.The level of serum amylase before and 3,24 h after ERCP and the incidence of hyperamvlasemia and pancreatitis after ERCP were compared between two groups.Result No significant difference of serum amylase were observed between two groups before E RCP (78.0-± 6.9 vs 87.8 ± 7.8,P ＞ 0.05),but the serum amylase in indomethacin group was significantly lower than that in control group 3 and 24 h after ERCP[175.6 ± 67.7 vs 438.6 ±77.4,P ＜0.01,227.8 ±37.3 vs 239.8 ±38.1,F =19.93,P ＜0.01)].The incidence of hyperamvlasemia after ERCP in indomethacin group was significantly lower than that in control group(3.2％ vs 5.6％,P ＜0.01),the incidence of post-ERCP pancreatitis in indomethacin group was significantly lower than that in control group (7.4％ vs 12.5 ％,P ＜ 0.01).Conclusion Rectal administration of indomethacin before ERCP can prevent pancreatitis and postoperative hyperamvlasemia,which can be used as a routine prevention method.