药物预防ERCP术后急性胰腺炎的临床对照研究

摘要

Objective:To evaluate the effectiveness of the different drugs administered at different time for prevention of post-endoscopic retrograde cholan-giopancreatography(ERCP) pancreatitis(PEP),and analyze the related risk factors associated with PEP.Methods:The total patients were allocated to three groups of lower risks(Ls1,Ls2,L0) and four groups of higher risks(Hs1,Hs2,Hg1,Hg2) on previously defined inclusion criteria,and managed with either somatostatin or gabexate as protocol.The serum amylase and c-reactive protein(CRP) levels were determined within the 12 h before ERCP and at 3, 12 and 24 h after ERCP,respectively(CRP measurement was free 3 h after operation).Results:Of the 75 patients included in the lower risk groups,com-plicated hyperamylasemia was seen in 7(9.3%) and PEP in 2(2.7%),and in 295 high risk patients,heperamylasemia occurred in 29(9.8%) and PEP in 14(4.7%).The difference was not significant in the two groups regarding PEP and hyperamylasemia as well as CRP before operation and at 12 h and 24 h after operation (P>0.05),whereas in higher risk group,the incidence of hyperamylasemia and levels of serum amylase at 12 h and CRP at 24 h after operation were different (P<0.05),in which the incidence and levels of serum amylase at 12 h and CRP at 24 h after operation were lower in Hs1(soma-tostatin used before operation) as compared with subgroups of Hg1 and Hg2(P<0.05),and the patients treated with somatostatin(Hs1+s2) had a lower in-cidence of PEP and hyperamylasemia than those with gabexate(Hg1+g2)(P<0.05).In addition,the patients in higher risk groups with a history of pan-creatitis,multiple duodenal papilla intubation before angiography and surgical time over 1 hour had relatively higher rates of pancreatitis and hyperamy-lasemia(P<0.05).Conclusion:Patients with higher risk factors are recommended to be managed with somatostatin before ERCP to reduce incidence of PEP or hyperamylasemia,and prophylactic medication may be free for those of lower risks.Generally,somatostatin may produce better results than gabexate does.Patients with a history of pancreatic duct,multiple duodenal papilla intubation before angiography and surgical time are the major risk factors for PEP.%目的：对照研究使用不同药物和不同时间点给药时，药物对PEP的预防作用；分析PEP的危险因素。方法：根据入选标准，将ERCP患者分为三个低危组（Ls1、Ls2、L0）和四个高危组（Hs1、Hs2、Hg1、Hg2），按照既定方案给予生长抑素或加贝酯。观察入组病例的术前12 h以内、术后3 h、12 h、24 h的血淀粉酶和C反应蛋白（后者术后3 h不检测）。结果：低危组入选75例，并发高淀粉酶血症7例（9．3％）、急性胰腺炎2例（2．7％）；高危组入选295人，并发高淀粉酶血症29例（9．8％）、急性胰腺炎14例（4．7％）。低危组之间高淀粉酶血症和急性胰腺炎的发生率，以及术前、术后12 h和术后24 h CRP、血淀粉酶的比较差异均无统计学意义（P＞0．05）。高危组之间高淀粉酶血症发生率，以及术后12 h血淀粉酶和术后24 h CRP的总体比较，差异具有统计学意义（P＜0．05），其中Hs1组（术前使用生长抑素）的高淀粉酶血症的发生率、术后12 h血淀粉酶和术后24 h CRP水平低于Hg1和Hg2组，差异有统计学意义（P＜0．05）；使用生长抑素者（Hs1＋s2组）的胰腺炎和高淀粉酶血症的发生率低于使用加贝酯者（Hg1＋g2组）（P＜0．05）。具有胰腺炎病史、乳头多次插管和手术时间超过1h的高危组患者，其发生胰腺炎和高淀粉酶血症的可能性较高。结论：具有高危因素的患者，建议术前使用生长抑素以减少胰腺炎或高淀粉酶血症的发生，效果优于加贝酯；无高危因素的患者不建议预防性用药。患者的胰胆管病史、乳头插管次数和手术时间是PEP的主要危险因素。