不同蛋白酶抑制剂预防胆总管结石患者内镜逆行胰胆管造影术后胰腺炎的临床对照研究

Different protease inhibitors in prevention of pancreatitis after endoscopic retrograde cholangiopancreatography for calculus of common bile duct

摘要:

目的 探讨生长抑素和奥曲肽预防胆总管结石患者内镜逆行胰胆管造影术（ERCP）后胰腺炎的临床效果。方法 选取2018年4月－2021年4月该院收治的116例择期行ERCP的胆总管结石患者作为研究对象，通过随机数表法，将其分为观察组和对照组，每组各58例。观察组使用生长抑素治疗，对照组使用奥曲肽治疗。观察两组患者胰腺炎和高淀粉酶血症发生情况，检测两组患者术前、术后3和24 h血淀粉酶水平，通过视觉模拟评分法（VAS）比较两组患者术后3、24和48 h的疼痛程度，记录两组患者住院费用、住院时间和不良反应发生率。结果 两组患者术后胰腺炎发生率、高淀粉酶血症发生率、术前、术后3和24 h血淀粉酶水平、术后3、24和48 h的VAS、住院时间和不良反应发生率比较，差异均无统计学意义（P > 0.05）。观察组住院费用明显低于对照组（P < 0.05）。结论 生长抑素和奥曲肽预防ERCP术后胰腺炎疗效相当，均具有较高的安全性，临床可根据患者的个体情况，采取不同的用药方案。

Abstract:

Objective To investigate the clinical effect of somatostatin and octreotide in prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones.Methods 116 patients with common bile duct stones underwent ERCP elective surgery from April 2018 to April 2021 were included in the study. They were divided into observation group and control group by random number table method, with 58 cases in each group. The observation group was treated with somatostatin and the control group was treated with octreotide. The incidence of pancreatitis and hyperamylasemia was observed between the two groups. The blood amylase levels of the two groups before operation and 3 and 24 h after operation were detected. Visual analogue scale (VAS) was used to compare the pain degree of the two groups at 3, 24 and 48 h after operation, the hospitalization cost, length of hospital stay, and the adverse reactions between the two groups were observed.Results There were no significant differences in the occurrence probability of postoperative pancreatitis and hyperamylasemia, blood amylase level before operation, 3 and 24 h after operation, VAS at 3, 24 and 48 h after operation, length of hospital stay, and probability of adverse reactions between the two groups (P > 0.05). The hospitalization cost of the observation group was significantly lower than that of the control group (P < 0.05).Conclusion The efficacy of somatostatin and octreotide in prevention of postoperative pancreatitis after ERCP is comparable, and both have high safety, and different drug regimen can be adopted according to the clinical situation of patients.