低分子量肝素预防ERCP术后急性胰腺炎的临床研究

目的：探讨低分子量肝素（LMWH）预防ERCP术后急性胰腺炎发生的作用。方法：将60例患者随机分成ERCP组（E组）和ERCP术前LMWH预处理组（H组），每组30例。观察ERCP术后患者的腹痛程度，血清淀粉酶（ AMS），内毒素（ET），一氧化氮（NO）、白细胞介素6（IL-6）等生化指标以及B超下胰腺形态学变化;观察H组术前术后的凝血功能变化。结果：E组腹痛症状加重者5例（16.7％，5/30），明显高于H组（0，0/30）（P<0.05）。两组患者术前各项生化指标水平均无显著差异（P>0.05），术后4h、24hE组血清ET和AMS水平明显高于H组（P<0.05），24h达高峰;E组血清NO水平明显低于H组（P<0.05）;E组各时点IL-6水平均明显高于H组（均P<0.05）。B超下E组1例胰腺有急性炎性改变，H组无凝血功能变化。结论：LMWH能预防或减轻ERCP术后胰腺急性炎症的发生，是一种简便、经济而安全的方法。其机制可能是通过改善微循环、降低炎症介质水平来实现的。

Clinical study on the prevention of acute pancreatitis after ERCP with low molecular weight heparin

Objective To explore whether low molecular weight heparin(LMWH) could prevent acute(pancreatitis) after ERCP and its clinical significance.Methods Sixty patients were randomly divided into 2 groups(30 in each group): ERCP group (E group),LMWH prevention group(H group).Changes of(abdominal) pain,biochemical parameters of amylase(AMS),endotoxin(ET),interleukin-6(IL6),nitricogen oxide(NO) and pancreatic morphology under ultrasonography between the two groups were investigated.(Changes) of coagulation function in H group before and after ERCP were also studied.Results Abdominal pain of 5 patients in E group(16.7%) was aggravated,but none of H group.There were no significant differences in the values of biochemical parameters and pancreatic morphology between the two groups before ERCP.The values of AMS,ET in E group were significantly higher at 4h and 24h after ERCP than those of H group(P<0.05);meanwhile the values of NO in H group were significantly higher at 4h and 24h than those of E group(P<0.05).The values of IL6 in E group were significantly higher after ERCP than those of H group at all time points(P<0.05).One patient in E group had acute inflammatory change of(pancreas) under ultrasonography.No obvious change of coagulation function was observed after ERCP in H group(P>0.05).Conclusions LMWH therapy may prevent or reduce the occurrence of acute(pancreatitis) in those who undergo ERCP by improving microcirculation and reducing the release of inflammatory mediators,and is a simple,economic and safe method.