目的：直肠给予50-100 mg非甾体类抗炎药(NSAID；双氯芬酸或消炎痛)可预防内镜逆行胰胆管造影术后胰腺炎(PEP)的发生。然而，这比给一般日本患者服用25mg的剂量要高。此项研究的目的是评价剂量25mg的双氯芬酸直肠给药预防ERCP术后胰腺炎的安全性和有效性。
方法：2016年1月至2017年3月，共147例患者在行ERCP手术前20 分钟直肠给予25 mg双氯芬酸或者空白对照剂。对该剂量双氯芬酸预防ERCP术后胰腺炎的有效性和安全性进行回顾性分析。
结果：13例患者(8.8%)发生ERCP术后胰腺炎：双氯芬酸组3例(4.1%)，对照组10例(13.7%)(p=0.0460)。ERCP术后无消化道出血、溃疡、急性肾功能衰竭或死亡病例。多因素Logistic回归分析显示：不使用双氯芬酸直肠给药是发生ERCP术后胰腺炎的危险因素(优势比=3.530；95%可信区间=1.017-16.35；p=0.0468)。
结论：直肠给予剂量25 mg双氯芬酸可预防ERCP术后胰腺炎的发生。
The Effectiveness of the Rectal Administration of Low-dose Diclofenac for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis.
Okuno M, Shiroko J, Taguchi D, et al.[J]. Internal Medicine, 2018.
Objective：A 50-100-mg rectal dose of nonsteroidal anti-inflammatory drugs (NSAIDs; diclofenac or indomethacin) has been shown to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). However, this is higher than the recommended 25-mg dose that is commonly administered to Japanese patients. The objective of this study was to evaluate the safety and efficacy of 25-mg rectal dose of diclofenac in preventing PEP.
Methods ：Between January 2016 and March 2017, a total of 147 patients underwent ERCP with or without the rectal administration of diclofenac (25 mg) 20 min before the procedure. A retrospective analysis was conducted to evaluate the efficacy and safety of this dose in preventing PEP.
Results：Thirteen patients (8.8%) developed PEP: 3 patients (4.1%) in the diclofenac group and 10 (13.7%) in the control group (p=0.0460). After ERCP, there were no cases of gastrointestinal hemorrhage, ulceration, acute renal failure, or death. A multivariate logistic regression analysis revealed that the non-administration of rectal diclofenac was a risk factor for PEP (odds ratio=3.530; 95% confidence interval=1.017-16.35; p=0.0468).
Conclusions： A 25-mg rectal dose of diclofenac might prevent PEP.
翻译：胡越 审校：张立超，侯森林
