吲哚美辛栓预防高危人群发生内镜逆行胰胆管造影术后胰腺炎给药时机的前瞻性研究

Timing of Indomethacin suppositories for the prevention of post-ERCP pancreatitis in high risk groups

摘要:

目的   探讨吲哚美辛栓预防高危人群发生内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）的最佳给药时间。方法   81例患者随机分为A组（术后立即给予吲哚美辛栓100 mg纳肛）、B组（术后30 min给予吲哚美辛栓100 mg纳肛）和C组（单纯常规处理组）。分别测术前、术后3、24及48 h血清C反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、血淀粉酶及尿淀粉酶等指标。结果   A组ERCP术后PEP（4.00%）、B组（5.41%）均明显低于C组（26.31%）（P <0.05）；A组（4.00%）、B组（13.51%）术后高淀粉酶血症发生例数均明显低于C组（31.6%）（P <0.05）。A组和B组之间的PEP及高淀粉酶血症发生率差异均无统计学意义（P >0.05）。结论   ERCP术后立即或术后30 min经直肠给予吲哚美辛栓100 mg均能够有效降低PEP和术后高淀粉酶血症的发生率。

Abstract:

Objective A prospective randomized controlled trial was carried out to explore the best time of Indomethacin suppositories administration for the prevention of post-ERCP pancreatitis in high-risk groups. Methods 81 patients were enrolled in the study finally. Patients were randomized into group A (100 mg rectal Indomethacin suppositories was administrated immediately after ERCP), group B (100 mg rectal Indomethacin suppositories was administrated half an hour after ERCP) and group C (ERCP alone group, which did not give Indomethacin suppositories). The level of serum amylase, urine amylase, serum CRP, serum IL-6, serum TNF-α were measured before, 3 h, 24 h and 48 h after ERCP, and the incidence of PEP and hyperamylasemia were analyzed. Results  There was 1 case (4.00 %) of PEP in group A, 2 cases (5.41 %) of PEP in group B and 5 cases (26.31 %) of PEP in group C; the incidences of PEP of group A and group B were significant lower than that in group C (P < 0.05). There was 1 case (4.00 %) of hyperamylasemia in group A, 5 cases (13.51 %) of hyperamylasemia in group B and 6 cases (31.6 %) of hyperamylasemia in group C, and the incidences of hyperamylasemia of group A and group B were significant lower than that in group C (P < 0.05). Conclusion Administration of 100 mg Indomethacin suppositories immediately or half an hour after ERCP can effectively reduce the incidence of PEP and hyperamylasemia.