本文選題：內(nèi)鏡逆行胰膽管造影術(shù) + 膽總管結(jié)石　； 參考：《中國(guó)藥房》2017年14期

【摘要】：目的:評(píng)價(jià)生長(zhǎng)抑素、烏司他丁、奧曲肽和加貝酯預(yù)防膽總管結(jié)石患者內(nèi)鏡逆行胰膽管造影(ERCP)術(shù)后高淀粉酶血癥和胰腺炎的經(jīng)濟(jì)性。方法:收集我院2008年7月-2016年4月經(jīng)ERCP診療的316例膽總管結(jié)石患者的病歷資料,按蛋白酶抑制劑使用情況分成空白對(duì)照組(58例)、生長(zhǎng)抑素組(64例)、烏司他丁組(65例)、奧曲肽組(68例)和加貝酯組(61例)。ERCP術(shù)前,空白對(duì)照組患者給予禁食、靜脈營(yíng)養(yǎng)支持、抑酸等常規(guī)治療;在此基礎(chǔ)上,其余4個(gè)藥物組患者均于手術(shù)前6 h開(kāi)始按照說(shuō)明書(shū)進(jìn)行預(yù)防用藥。比較5組患者ERCP術(shù)后高淀粉酶血癥和胰腺炎的發(fā)生率,術(shù)后3、24、48 h視覺(jué)模擬法(VAS)評(píng)分,以及不良反應(yīng)發(fā)生情況。采用成本-效果分析法評(píng)定各組治療方案的經(jīng)濟(jì)性。結(jié)果:與空白對(duì)照組比較,生長(zhǎng)抑素組、烏司他丁組、奧曲肽組和加貝酯組患者的住院時(shí)間顯著縮短,高淀粉酶血癥和胰腺炎的發(fā)生率顯著降低,術(shù)后3、24、48 h的VAS評(píng)分顯著降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。4個(gè)藥物組之間比較,上述考察指標(biāo)均無(wú)明顯差異,不良反應(yīng)發(fā)生率均較低且差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。生長(zhǎng)抑素組的成本-效果比最低,最具有成本效果優(yōu)勢(shì);增量成本-效果比及敏感度分析結(jié)果也證實(shí)此結(jié)果。結(jié)論:生長(zhǎng)抑素、烏司他丁、奧曲肽和加貝酯均能有效預(yù)防ERCP術(shù)后高淀粉酶血癥和胰腺炎的發(fā)生,減輕患者疼痛,并具有較高的安全性。其中,生長(zhǎng)抑素能以最低成本取得最佳療效,為抑制ERCP術(shù)后高淀粉酶血癥和胰腺炎的最合理方案。
[Abstract]:Objective: to evaluate the effect of somatostatin, ulinastatin, octreotide and Gabectin on the prevention of hyperamylase and pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis. Methods: the medical records of 316 cases of choledocholithiasis diagnosed and treated by ERCP from July 2008 to April 2016 in our hospital were collected. According to the usage of protease inhibitor, the patients were divided into control group (n = 58), somatostatin group (n = 64), urinastatin group (n = 65) and octreotide group (n = 68). On the basis of this, the patients in the other 4 groups were treated with prophylaxis according to the instructions 6 hours before operation. The incidence of hyperamylase and pancreatitis, visual analogue visual analogue (vas) score and adverse reaction were compared in 5 groups after ERCP. The cost-effect analysis was used to evaluate the economy of each group. Results: compared with the blank control group, the hospitalization time of the patients in the somatostatin group, ulinastatin group, octreotide group and Gabexate group was significantly shortened, the incidence of hyperamylase and pancreatitis was significantly decreased, and the VAS score at 3244h after operation was significantly decreased. The differences were statistically significant (P 0.05). There was no significant difference in the above indexes among the four drug groups, and the incidence of adverse reactions was lower and there was no significant difference in the incidence of adverse reactions (P 0.05). The cost-effect ratio of somatostatin group was the lowest, and the cost effect advantage was the most, and the incremental cost-effect ratio and sensitivity analysis also confirmed the result. Conclusion: somatostatin, ulinastatin, octreotide and Gabectin can effectively prevent the occurrence of hyperamylase and pancreatitis after ERCP, relieve pain and have high safety. Among them, somatostatin can obtain the best curative effect at the lowest cost. It is the most reasonable scheme to inhibit hyperamylase and pancreatitis after ERCP.
【作者單位】： 萍鄉(xiāng)市人民醫(yī)院/贛南醫(yī)學(xué)院附屬萍鄉(xiāng)醫(yī)院消化內(nèi)科;
【基金】：國(guó)家自然科學(xué)基金資助項(xiàng)目(No.81360080)
【分類號(hào)】：R575.7;R576

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