4种蛋白酶抑制剂预防胆总管结石患者ERCP术后高淀粉酶血症和胰腺炎的成本-效果分析

发布时间：2018-05-03 00:29

本文选题：内镜逆行胰胆管造影术 + 胆总管结石　；参考：《中国药房》2017年14期

【摘要】：目的:评价生长抑素、乌司他丁、奥曲肽和加贝酯预防胆总管结石患者内镜逆行胰胆管造影(ERCP)术后高淀粉酶血症和胰腺炎的经济性。方法:收集我院2008年7月-2016年4月经ERCP诊疗的316例胆总管结石患者的病历资料,按蛋白酶抑制剂使用情况分成空白对照组(58例)、生长抑素组(64例)、乌司他丁组(65例)、奥曲肽组(68例)和加贝酯组(61例)。ERCP术前,空白对照组患者给予禁食、静脉营养支持、抑酸等常规治疗;在此基础上,其余4个药物组患者均于手术前6 h开始按照说明书进行预防用药。比较5组患者ERCP术后高淀粉酶血症和胰腺炎的发生率,术后3、24、48 h视觉模拟法(VAS)评分,以及不良反应发生情况。采用成本-效果分析法评定各组治疗方案的经济性。结果:与空白对照组比较,生长抑素组、乌司他丁组、奥曲肽组和加贝酯组患者的住院时间显著缩短,高淀粉酶血症和胰腺炎的发生率显著降低,术后3、24、48 h的VAS评分显著降低,差异均有统计学意义(P0.05)。4个药物组之间比较,上述考察指标均无明显差异,不良反应发生率均较低且差异无统计学意义(P0.05)。生长抑素组的成本-效果比最低,最具有成本效果优势;增量成本-效果比及敏感度分析结果也证实此结果。结论:生长抑素、乌司他丁、奥曲肽和加贝酯均能有效预防ERCP术后高淀粉酶血症和胰腺炎的发生,减轻患者疼痛,并具有较高的安全性。其中,生长抑素能以最低成本取得最佳疗效,为抑制ERCP术后高淀粉酶血症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.
【作者单位】：萍乡市人民医院/赣南医学院附属萍乡医院消化内科;
【基金】：国家自然科学基金资助项目(No.81360080)
【分类号】：R575.7;R576

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