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目的:评估头孢他啶预防内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)的疗效。方法:选取456例待行ERCP的患者,将患者随机分为头孢他啶组与双氯芬酸钠组,术前,双氯芬酸组患者接受100mg双氯芬酸钠直肠给药和安慰剂静脉滴注,头孢他啶组患者给予2g头孢他啶静脉注射和安慰剂直肠给药。比较两组患者PEP的发病率和疾病程度,评估PEP发生的危险因素,评估血清和淀粉酶水平、腹痛VAS评分对PEP的早期预测价值。结果:两组患者的PEP发生率与疾病程度比较差异无统计学意义(P>0.05);年龄>45岁对于PEP的发生有显著的预测作用(RR=0.17,95%CI:0.04-0.75,P<0.05);腹痛VAS评分、血清与尿淀粉酶水平的ROC曲线下表面积分别为0.996(95%CI:0.992-0.999,P<0.0001)、0.882(95%CI:0.851-0.938,P<0.0001)和0.897(95%CI:0.862-0.946,P<0.0001)。结论:对于非甾体类抗炎药禁用且待行ERCP的患者,头孢他啶可作为预防PEP的替代品。
Objective: To evaluate the efficacy of ceftazidime in preventing postoperative pancreatitis (PEP) after endoscopic retrograde cholangiopancreatography (ERCP). Methods: A total of 456 ERCP patients were enrolled. The patients were randomly divided into ceftazidime group and diclofenac sodium group. Patients in preoperative diclofenac group received 100 mg diclofenac sodium rectally and placebo intravenous infusion. Patients in ceftazidime group received 2 g ceftazidime intravenously Injection and placebo rectal administration. The incidence and severity of PEP in both groups were compared. The risk factors of PEP were evaluated. The serum and amylase levels and the VAS score of abdominal pain were evaluated for the early predictive value of PEP. Results: There was no significant difference in the incidence of PEP and disease between the two groups (P> 0.05). The age of 45 years had significant predictive value for the occurrence of PEP (RR = 0.17, 95% CI: 0.04-0.75, (95% CI: 0.992-0.999, P <0.0001), 0.882 (95% CI: 0.851-0.938, P <0.0001, P <0.05). The VAS scores of abdominal pain and the serum and urine amylase levels under the ROC curve were 0.996 ) And 0.897 (95% CI: 0.862-0.946, P <0.0001). Conclusion: Ceftazidime may be used as a substitute for prophylaxis of PEP in patients with non-steroidal anti-inflammatory drugs banned and on-going ERCP.