本文選題：內(nèi)鏡下逆行胰膽管造影術(shù)后急性胰腺炎　切入點(diǎn)：胰膽管造影術(shù)　出處：《西南醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:內(nèi)鏡下逆行胰膽管造影術(shù)(Endoscopic Retrograte Cholang-iopancreatography,ERCP)是一門廣泛使用的進(jìn)行診斷和治療膽道與胰腺相關(guān)性疾病的技術(shù),包括膽總管結(jié)石、良性或惡性胰膽管狹窄等。ERCP術(shù)后急性胰腺炎(post-ERCP pancreatitis,PEP)是ERCP術(shù)后最常見(jiàn)的并發(fā)癥,發(fā)病率約為2-10%。輕度PEP可以延長(zhǎng)住院時(shí)間,然而重度PEP可以引起出血性胰腺炎,胰腺壞死,多器官功能衰竭甚至死亡。ERCP術(shù)后誘發(fā)的全身炎癥反應(yīng)是引起PEP的病理生理性事件;然而截至目前,確切的發(fā)病機(jī)制尚不能完全闡明。目前研究表明:磷脂酶A2(phospholipase A2,PLA2)是參與急性胰腺炎炎癥級(jí)聯(lián)反應(yīng)的重要因子;作為一種有效的PLA2抑制劑,直腸途徑應(yīng)用非甾體類抗炎藥(non-steroidal anti-inflammatory drugs,NSAIDS)在臨床上已經(jīng)被廣泛應(yīng)用于預(yù)防PEP。一些相關(guān)的Meta分析研究表明:直腸途徑應(yīng)用NSAIDS對(duì)于預(yù)防PEP是安全有效的;然而最新的隨機(jī)對(duì)照試驗(yàn)(randomized controlled trial,RCT)研究表明:單次劑量的吲哚美辛(100mg)相比安慰劑并不能有效預(yù)防PEP;不同國(guó)家之間的指南對(duì)于直腸途徑應(yīng)用NSAIDS預(yù)防PEP的有效性和安全性仍存在爭(zhēng)議。目的:采用Meta分析方法,評(píng)估直腸途徑應(yīng)用NSAIDS預(yù)防PEP的安全性及有效性,并提供最新的研究結(jié)果來(lái)揭示何種類型NSAIDS和給藥時(shí)間將更加有效。方法:計(jì)算機(jī)檢索萬(wàn)方數(shù)據(jù)庫(kù)(wanfangdata)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(cbm)、維普(vip)、中國(guó)知網(wǎng)(cnki)、cochranelibrary、pubmed、embase、ovid和webofscience等國(guó)內(nèi)外數(shù)據(jù)庫(kù),獲取已檢索研究資料的參考文獻(xiàn),收集直腸給藥途徑應(yīng)用nsaids預(yù)防pep的隨機(jī)對(duì)照試驗(yàn)(rct)研究,應(yīng)用cochrane協(xié)作網(wǎng)提供的“偏倚風(fēng)險(xiǎn)評(píng)估”工具和“改良jadad量表”,對(duì)收集的文獻(xiàn)進(jìn)行偏倚風(fēng)險(xiǎn)和質(zhì)量評(píng)估,提取文獻(xiàn)數(shù)據(jù),并應(yīng)用cochrane協(xié)作網(wǎng)推薦的revman5.3軟件進(jìn)行meta分析。本研究的主要終點(diǎn)是評(píng)估直腸給藥途徑應(yīng)用nsaids對(duì)于預(yù)防pep的有效性;并對(duì)不同類型的nsaids、普通和高危患者以及不同給藥時(shí)間進(jìn)行亞組分析,評(píng)估其降低風(fēng)險(xiǎn)值。結(jié)果:本研究最終納入12篇隨機(jī)對(duì)照試驗(yàn)(rct)文獻(xiàn),共3989例患者(nsaids組2016例,安慰劑組1973例)進(jìn)行meta分析,結(jié)果表明:1)在高危組和普通組患者中直腸途徑應(yīng)用nsaids相比安慰劑明顯降低了pep發(fā)病率(rr=0.52,95%ci(0.43,0.64),p0.01);2)直腸給藥途徑應(yīng)用nsaids相比安慰劑明顯降低了中重度pep發(fā)病率(rr=0.44,95%ci(0.28,0.69),p=0.01);3)直腸給藥途徑應(yīng)用吲哚美辛和雙氯芬酸鈉以及nsaids的不同給藥時(shí)間(ercp術(shù)前或術(shù)后)均不會(huì)對(duì)其療效造成影響。結(jié)論:直腸給藥途徑應(yīng)用nsaids在高危組和普通組患者中對(duì)于預(yù)防pep均是安全有效的;并且nsaids預(yù)防pep的有效性并不受給藥時(shí)間(ercp術(shù)前或術(shù)后)和藥物種類(雙氯芬酸鈉或吲哚美辛)的影響。
[Abstract]:Background: Endoscopic Retrograte Cholang-iopancreatography (ERCP) is a widely used technique for the diagnosis and treatment of biliary tract and pancreatic related diseases, including choledocholithiasis. Acute pancreatitis after ERCP is the most common complication, the incidence of which is about 2-10. Mild PEP can prolong hospital stay, but severe PEP can cause hemorrhagic pancreatitis and pancreatic necrosis. The systemic inflammatory response induced by multiple organ failure or even death after ERCP is the pathophysiological event of PEP. The exact pathogenesis has not been fully elucidated. At present, studies have shown that phospholipase A _ 2 / phospholipase A _ 2 / PLA _ 2 is an important factor involved in inflammatory cascade reaction in acute pancreatitis, and is an effective inhibitor of PLA2. The application of non-steroidal anti-inflammatory drug NSAIDSs in rectum pathway has been widely used in the prevention of PEP.A number of related Meta analysis studies have shown that the application of NSAIDS in rectal pathway is safe and effective for the prevention of PEP. However, the latest randomized controlled trial randomized controlled trialcitrate study showed that a single dose of indomethacin 100mg was not effective in preventing PEPs compared with placebos; guidelines for the use of NSAIDS in different countries were effective and safe for the rectal approach to the prevention of PEP. Sex is still controversial. Objective: to use Meta analysis method, To evaluate the safety and efficacy of rectal NSAIDS in the prevention of PEP. The latest research results were also provided to reveal which types of NSAIDS and administration time would be more effective. Methods: the database of Wanfang, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, and the domestic and foreign databases, such as the Chinese Medical Literature Database, the Chinese Biomedical document Database, the Chinese Biomedical document Database, the Chinese Biomedical Literature Database, the Chinese Biomedical Literature Database, and the Chinese Biomedical Literature Database, etc., were searched by computer and compared with the other domestic and foreign databases. A randomized controlled trial of rectal administration with nsaids to prevent pep was conducted. Using the "bias risk assessment" tool provided by cochrane cooperation network and the modified jadad scale, the bias risk and quality of the collected literature were evaluated, and the literature data were extracted. The main end point of this study was to evaluate the efficacy of rectal administration of nsaids in the prevention of pep. The subgroup analysis of different types of nsaids, common and high risk patients, and different administration time were carried out to evaluate the risk reduction value. Results: this study included 12 randomized controlled trials (RCT) literature, including 3 989 patients with nsaids (2016 cases). Meta analysis was performed in the placebo group (1973 cases). The results showed that nsaids significantly decreased the incidence of pep in high risk group and general group compared with placebo. Rectal administration of nsaids significantly decreased the incidence of moderate and severe pep compared with placebo. The effect of indomethacin, diclofenac sodium and different time of administration of nsaids before or after operation was not affected. Conclusion: rectal administration of nsaids is effective in preventing pep in high risk group and normal group. Are safe and effective; The efficacy of nsaids in the prevention of pep was not affected by the time of administration before or after operation and the type of drug (diclofenac sodium or indomethacin).
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R576

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