大黄保留灌肠对内镜下逆行胰胆管造影术后胰腺炎和高淀粉酶血症的影响

目的:探讨大黄保留灌肠对内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术后胰腺炎(post-ERCP pancreatitis,PEP)和高淀粉酶血症(hyperamylasemia,PEPH)的预防作用。方法:314例须行ERCP的患者随机分为观察组158例,对照组156例。对照组在一般治疗基础上于术后给予质量分数0.9%氯化钠溶液保留灌肠;观察组在一般治疗基础上于术后加用大黄保留灌肠。比较两组治疗后PEP与PEPH发生率,术后6 h、12 h及24 h血清淀粉酶(serum amylase,AMS)水平,术后24 h腹痛视觉模拟评分法(visual analogue scale,VAS)评分,术后AMS恢复正常时间及住院时间。结果:观察组治疗后PEP及PEPH发生率依次为1.90%、15.19%,显著低于对照组的8.97%和36.54%(P0.01);术后6 h、12 h及24 h血清AMS水平分别为(198.46±25.83)U·L~(-1)、(136.84±17.83)U·L~(-1)、(92.16±14.67)U·L~(-1),均显著低于对照组同期水平(P0.01);术后24 h腹痛VAS评分为(1.23±0.38)分,显著低于对照组的(1.87±0.46)分(P0.01);术后AMS恢复正常时间及住院时间依次为(2.65±0.83)d、(7.83±1.42)d,均显著短于对照组(P0.01)。结论:患者ERCP术后加用大黄保留灌肠能有效预防PEP和PEPH。

Effect of Rhubarb Retention Enema on Pancreatitis and Hyperamylasemia After Endoscopic Retrograde Cholangiopancreatography

Objective:To investigate the preventive effect of rhubarb retention enema on post-ERCP pancreatitis (PEP) and hyperamylasemia (PEPH) after endoscopic retrograde cholangiopancreatography (ERCP).Methods:Three hundred and fourteen patients with ERCP were randomly divided into observation group (158 cases) and control group (156 cases).The control group was given 0.9％ sodium chloride solution retention enema on the basis of general treatment,and the observation group was treated with rhubarb retention enema after the general treatment.The levels of serum amylase (AMS),the visual analogue scale (VAS) score of abdominal pain 24 hours after operation,the postoperative AMS scores of PEP and PEPH at 6 h,12 h,the restoration time and hospital stay time between the two groups were compared.Results:The incidence of PEP and PEPH of the observation group were 1.90％,15.19％,which were significantly lower than those (8.97％ and 36.54％),of the control group (P ＜ 0.01).The serum AMS levels at 6 h,12 h and 24 h after operation of the observation group were (198.46 ± 25.83) U · L-1,(136.84 ± 17.83)U · L-1 and (92.16 ± 14.67) U · L 1,which were significantly lower than those of the control group (P ＜ 0.01).The VAS score of abdominal pain 24 hours later was (1.23 ± 0.38),which was significantly lower than that (1.87 ± 0.46) of the control group (P ＜ 0.01).The mean recovery time of AMS and hospital stay time of the observation group were (2.65 ± 0.83) d,which were significantly shorter than that,namely,(7.83 ± 1.42) d,of the control group (P ＜ 0.01).Conclusion:ERCP plus rhubarb retention enema can effectively prevent PEP and PEPH,with higher effectiveness-cost ratio.