鼻膽管引流聯合甲硝唑灌注對預防逆行胰膽管造影術后高淀粉酶血癥和胰腺炎的臨床研究

尹毅霞 黃贊松 何守搞

【摘要】 目的 探討鼻膽管引流（EBND）聯合甲硝唑灌注對逆行胰膽管造影（ERCP）術后高淀粉酶血癥（PEPH）和ERCP術后胰腺炎（PEP）發生的預防作用。方法 選擇2013年8月～2016年8月期間在右江民族醫學院附屬醫院經B超、MRI和磁共振胰膽管造影（MRCP）證實為膽總管結石并成功實施ERCP+十二指腸乳頭括約肌切開術（EST）+取石術+EBND治療的70例住院患者，按隨機數字表分為兩組，每組35例，實驗組給予甲硝唑注射液100 ml灌注、沖洗，30 min/次，2次/d，連用5天；對照組給予0.9%氯化鈉注射液100 ml灌注、沖洗，30 min/次，2次/d，連用5天。觀察兩組患者術前及術后2 h、12 h、24 h、48 h血淀粉酶水平的變化情況。結果 術前兩組血清淀粉酶比較差異無統計學意義（P>0.05）；術后12 h、24 h、48 h兩組血清淀粉酶均升高，差異均有統計學意義（P<0.01），且對照組術后12 h、24 h、48 h血清淀粉酶含量明顯高于實驗組，差異均有統計學意義（P<0.001）。 實驗組與對照組PEPH發生率分別為14.29%、37.10%，實驗組PEPH發生率明顯低于對照組，差異有統計學意義（P<0.05）。實驗組PEP發生率為2.86%，低于對照組的14.29%，但比較差異無統計學意義（P>0.05）。兩組患者均未出現嚴重不良反應。結論 EBND聯合甲硝唑灌注能有效降低PEPH的發生，局部高濃度用藥有利于提高療效，方法簡單易行，安全可靠，患者易于接受且耐受度高，值得臨床推廣和應用。

【關鍵詞】 鼻膽管引流；逆行胰膽管造影；高淀粉酶血癥；胰腺炎；甲硝唑；療效

中圖分類號：R616.5；R657.5+1 文獻標識碼：A DOI：10.3969/j.issn.10031383.2018.04.003

【Abstract】 Objective To investigate the preventive effect of endoscopic nasobiliary drainage（EBND） combined with metronidazole infusion on postERCP hyperamlyasemia （PEPH） and postERCP pancreatitis（PEP）.Methods 70 inpatients who were confirmed with choledocholithiasis by Bultrasound，MRI and magnetic resonance cholangiopancreatography（MRCP） and treated with ERCP + endoscopic sphincterotomy（EST） + stone extraction + EBND in Affiliated Hospital of Youjiang University for Nationalities from August 2013 to August 2016 were selected.They were divided into experimental group and control group according to random number table，with 35 cases in each group.The experimental group were perfused with metronidazole injection （100 ml） and rinsed for 30 min/twice a day for 5 days.The control group were perfused with 0.9% sodium chloride injection （100 ml） and rinsed for 30 min/twice a day for 5 days.And then，the changes of serum amylase levels before operation and 2 h，12 h，24 h and 48 h after operation were observed in the two groups.Results There was no statistically significant difference in serum amylases between the two groups before operation（P>0.05）.12 h，24 h and 48 h after operation，however，the serum amylases increased in the two groups，and difference was statistically significant（P<0.01），and the serum amylase contents in the control group were significantly higher than those in the experimental group（P<0.001）.The incidence of PEPH in the experimental group and the control group was 14.29% and 37.10% respectively，and that in the experimental group was significantly lower than that in the control group，difference was statistically significant（P<0.05）.The incidence of PEP in the experimental group was 2.86%，which was lower than that in the control group（14.29%），but difference was not statistically significant（P>0.05）.No serious adverse reactions were found in the two groups.Conclusion EBND combined with metronidazole perfusion can effectively reduce the occurrence of PEPH，local high concentration medication is conducive to enhance curative effect，and the method is simple，safe and reliable.Patients are easy to accept and have high tolerance，so it is worthy of clinical popularization and application.

【Key words】 EBND；ERCP；hyperamlyasemia；pancreatitis；metronidazole；clinical efficacy

隨著內鏡技術的不斷改進和推廣，人們對內鏡下逆行胰膽管造影術（endoscopic retrograde cholangiopancreatography，ERCP）的認識和認可程度得到了進一步的提升。ERCP作為膽胰疾病微創治療的主要方法，其術后并發癥的風險不容忽略，嚴重時亦可危及生命。ERCP術后常見的并發癥包括ERCP術后胰腺炎（postERCP pancreatitis，PEP）、高淀粉酶血癥（postERCP hyperamlyasemia，PEPH）、膽道感染等，其中膽道感染率可達0.35%～20.4%[1]。本研究通過對在右江民族醫學院附屬醫院住院并成功實施ERCP+十二指……