CAJ | 학술논문

目的探讨双氯芬酸钠栓剂对ERCP术后胰腺炎和高淀粉酶血症的预防作用。方法将拟施行ERCP手术的240例患者按随机数字表法分为双氯芬酸钠组、生长抑素组和安慰剂常规治疗组，每组80例，观察其术前、术后4、24h血清淀粉酶水平，并评估ERCP术后胰腺炎和高淀粉酶血症发生率。结果3组患者ERCP术前血清淀粉酶均为正常值。双氯芬酸钠组及生长抑素组术后4、24h血清淀粉酶水平，均明显低于常规治疗组，差异均有统计学意义（均P＜0.01）；双氯芬酸钠组术后4h血清淀粉酶水平低于生长抑素组（P＜0.01），但术后24h两组差异无统计学意义（P＞0.05）。ERCP术后高淀粉酶血症发生率，双氯芬酸钠组及生长抑素组均明显低于常规治疗组，差异均有统计学意义（P＜0.05或0.01），但双氯芬酸钠组与生长抑素组之间差异无统计学意义（P＞0.05）。双氯芬酸钠组及生长抑素组ERCP术后胰腺炎发生率均明显低于常规治疗组，差异均有统计学意义（P＜0.05或0.01），但双氯芬酸钠组与生长抑素组之间，差异无统计学意义（P＞0.05）。结论应用双氯芬酸钠栓可有效降低ERCP术后胰腺炎及高淀粉酶血症的发生率；双氯芬酸钠与生长抑素均能有效预防ERCP术后胰腺炎及高淀粉酶血症的发生，且双氯芬酸钠比生长抑素在应用便利性及经济上更有优势。
목적탐토쌍록분산납전제대ERCP술후이선염화고정분매혈증적예방작용。방법장의시행ERCP수술적240례환자안수궤수자표법분위쌍록분산납조、생장억소조화안위제상규치료조，매조80례，관찰기술전、술후4、24h혈청정분매수평，병평고ERCP술후이선염화고정분매혈증발생솔。결과3조환자ERCP술전혈청정분매균위정상치。쌍록분산납조급생장억소조술후4、24h혈청정분매수평，균명현저우상규치료조，차이균유통계학의의（균P＜0.01）；쌍록분산납조술후4h혈청정분매수평저우생장억소조（P＜0.01），단술후24h량조차이무통계학의의（P＞0.05）。ERCP술후고정분매혈증발생솔，쌍록분산납조급생장억소조균명현저우상규치료조，차이균유통계학의의（P＜0.05혹0.01），단쌍록분산납조여생장억소조지간차이무통계학의의（P＞0.05）。쌍록분산납조급생장억소조ERCP술후이선염발생솔균명현저우상규치료조，차이균유통계학의의（P＜0.05혹0.01），단쌍록분산납조여생장억소조지간，차이무통계학의의（P＞0.05）。결론응용쌍록분산납전가유효강저ERCP술후이선염급고정분매혈증적발생솔；쌍록분산납여생장억소균능유효예방ERCP술후이선염급고정분매혈증적발생，차쌍록분산납비생장억소재응용편리성급경제상경유우세。
Objective To investigate the preventive effect of diclofenac sodium suppository for post- ERCP pancreatitis and hyperamylasemia. Methods A total of 240 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to receive diclofenac sodium suppository (n=80), intravenous somatostatin (n=80), or no special medi-cation (n=80). The levels of serum amylase before ERCP and 4h, 24h after ERCP were measured, and the rate of acute pancre-atitis and hyperamylasemia after ERCP were assessed. Results Serum amylase levels before ERCP of three groups were al normal. The mean serum amylase levels in diclofenac group at 4h after ERCP were significantly lower than those in somatostatin and control groups (102.47 ±56.24U/L, 132.53 ±60.45U/L, 195.64 ±58.62U/L, respectively, both P<0.05). The mean serum amylase levels of diclofenac group (89.37±53.21U/L) and somatostatin group (95.79±54.87 U/L) 24h after ERCP were signifi-cantly lower than those of control group (186.83±56.35U/L, P<0.05), while there was no difference between diclofenac group and somatostatin group(P>0.05). The incidence of hyperamylasemia after ERCP in diclofenac group(6.25%) and somatostatin group (7.50%) was significantly lower than that of control group (18.75%, P<0.05), while there was no difference between di-clofenac group and somatostatin group(P>0.05). The incidence of post- ERCP pancreatitis in diclofenac group(2.50%) and so-matostatin group (3.75%) were significantly lower than that of control group (12.50%, P<0.05), while there was no difference be-tween diclofenac group and somatostatin group (P>0.05). Conclusion Diclofenac sodium suppository and somatostatin can effectively reduce the incidence of acute pancreatitis and hyperamylasemia after ERCP, and the former is more cheep and con-venient.