奥曲肽对ERCP术后高淀粉酶血症及胰腺炎的预防疗效_临床医学论文.docVIP

奥曲肽对ERCP术后高淀粉酶血症及胰腺炎的预防疗效_临床医学论文 奥曲肽对ERCP术后高淀粉酶血症及胰腺炎的预防疗效_临床医学论文 【摘要】 　　目的 探讨奥曲肽对内镜逆行胆胰管造影（ERCP）术后高淀粉酶血症及胰腺炎的预防作用。 方法 行ERCP患者40例，随机分为两组：预防组20例，于术前1h静滴奥曲肽0.3mg+5% 葡萄糖液500ml，停止输注后6h和12h分别给予奥曲肽0.1mg皮下注射各1次。对照组20例，术前1h开始静脉滴注0.9%生理盐水500ml，既不使用奥曲肽治疗也不皮下注射生理盐水，并分别于术前、术后2、12及24h作血清淀粉酶测定，同时观察胰腺炎的发生情况。结果 预防组术后2、12及24h的血清淀粉酶（U/L）分别为(182.0±128.9)、(160.9±107.4)及(119.2±76.6)，低于对照组水平（195.5±140.8)、(243.8±292.5)和(172.0±251.0），但未达统计学意义。预防组未出现急性胰腺炎，对照组发生2例术后急性胰腺炎（0.05）。 结论 奥曲肽可预防ERCP术后急性胰腺炎的发生。 【关键词】 奥曲肽 ERCP 急性胰腺炎 高淀粉酶血症 　　【Abstract】 Objective To study the preventive effect of octreotide on the hyperamylasemia and pancretitis after ERCP(endoscopic retrograde cholangiopancreatography,ERCP). Methods 40 patients were randomly divided into 2 groups.One concluded 20 cases which were applied with octreotide 0.3mg+5%GS 500ml an hour before ERCP. 6 hours and 12hours after that,0.1mg octreotide would separately be applied again hypodermically . The other group also concluded 20 cases, which were given 0.9% NS 500ml an hour before ERCP. And this group was neither applied with octreotide nor NS hypodemically. The mean concentration of serum amylase before ERCP and 2h,12h,24h after ERCP was measured in all patients. And the abdominal pain and pancreatitis after ERCP were also abserved . Results The mean concentration of serum amylase at 2h,12h,24h after ERCP were (182.0±128.9)U/L，(160.9±107.4)U/L and (119.2±76.6)U/L in preventive group，and (195.5±140.8)U/L, (243.8±292.5)U/L,( 172.0±251.0)U/L in control group (Pgt;0.05).There was no post-ERCP pancreatitis in preventive group, but 2 cases of post-ERCP pancreatitis in control group. Conclusions Prophylactic treatment with octreotide reduces the incidence of post-ERCP pancreatitis. 　　【Key word】 Octreotide ERCP Acute pancreatitis Hyperamylasemia 　　内镜逆行胆胰管造影术（ERCP）是当前诊断肝、胆、胰疾病的重要手段之一。开展近30年来，目前已广泛应用于临床。但ERCP仍有一定的并发症，包括疼痛、出血、高淀粉酶血症和急性胰腺炎等。尤其是急性胰腺炎，其为ERCP的严重并发症,报导的发生率1%～40%不等，在多数前瞻性研究中平均发生率约5%［１］。而实施ERCP术的患者中，大约40%～50%［２］会出现血清胰酶升高而未发生急性胰腺炎，如何预防ERCP术后的