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目的探讨低分子右旋糖酐联合吲哚美辛栓剂对内镜逆行胰胆管造影术(ERCP)后胰腺炎的预防作用。方法 215例至少具备一项ERCP术后胰腺炎高危因素的患者术前随机分为四组。对照组(n=51)给予氯化钠注射液+安慰剂,吲哚美辛组(n=54)给予氯化钠注射液+吲哚美辛栓剂(术前单次经直肠给药50 mg),低分子右旋糖酐组(n=52)给予低分子右旋糖酐(术前单次静脉输注500 m L)+安慰剂,药物联用组(n=58)给予低分子右旋糖酐(术前单次静脉输注500 m L)+吲哚美辛栓剂(术前单次经直肠给药50 mg)。观察术后胰腺炎发生率、重症急性胰腺炎发生率及患者死亡率,记录住院时间。结果对照组、吲哚美辛组、低分子右旋糖酐组和药物联用组胰腺炎发生率分别为24%、15%、14%和5%,药物联用组ERCP术后胰腺炎发生率低于对照组(P<0.01);四组患者重症胰腺炎发生率以及死亡率无显著差异(P>0.05)。对照组、吲哚美辛组、低分子右旋糖酐组和药物联用组平均住院时间分别为(5.8±2.9)、(5.2±1.9)、(6.1±2.5)和(4.3±2.0)d,与其他三组相比,药物联用组术后平均住院时间缩短(P<0.05)。结论低分子右旋糖酐联合吲哚美辛栓剂对于ERCP术后胰腺炎有较好的预防作用。
Objective To investigate the preventive effect of low molecular dextran combined with indomethacin suppository on pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). Methods 215 patients with at least one risk factor for post-ERCP pancreatitis were randomly divided into four groups. The control group (n = 51) was given sodium chloride injection plus placebo and the indometacin group (n = 54) was given sodium chloride injection plus indometacin suppository (single rectal administration of 50 mg ), Low molecular dextran group (n = 52) given low molecular dextran (preoperative single intravenous infusion 500 m L) + placebo, drug combination group (n = 58) given low molecular weight dextran Infusion of 500 m L) + indometacin suppository (single rectal administration of 50 mg preoperatively). Observe the incidence of postoperative pancreatitis, the incidence of severe acute pancreatitis and patient mortality, record the length of stay. Results The incidence of pancreatitis in control group, indomethacin group, low molecular dextran group and drug combination group were 24%, 15%, 14% and 5% respectively. The incidence of pancreatitis after ERCP in the combination group was lower than (P <0.01). There was no significant difference in the incidence of severe pancreatitis and mortality between the four groups (P> 0.05). The median length of stay in the control group, indomethacin group, low molecular dextran group and drug combination group were (5.8 ± 2.9), (5.2 ± 1.9), (6.1 ± 2.5) and (4.3 ± 2.0) d, respectively, Compared with the three groups, the average postoperative hospital stay in the combination group was shorter (P <0.05). Conclusion Low molecular weight dextran combined with indometacin suppository has a good preventive effect on post-ERCP pancreatitis.