ercp术后胰腺炎及高淀粉酶血症危险因素分析及预防性应用肾上腺素的效果研究

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1、授予单位代码10089学号或申请号20153266中国图书分类号R657.5.硕士研究生论文专业学位ERCP术后胰腺炎及高淀粉酶血症危险因素分析及预防性应用肾上腺素的效果研究研究生：张卫导师：侯森林教授专业：外科学二级学院：河北医科大学第二医院2018年3月目录中文摘要················································································1英文摘要·······················································

2、·························2英文缩写················································································4研究论文ERCP术后胰腺炎及高淀粉酶血症危险因素分析及预防性应用肾上腺素的效果研究前言·················································································5材料与方法··································

3、······································6结果···············································································9附表···············································································13讨论·····································································

4、··········18结论··············································································23参考文献·········································································23综述ERCP术后相关并发症的防治进展······································27致谢··········································

5、······································43个人简历···············································································44中文摘要ERCP术后胰腺炎及高淀粉酶血症危险因素分析及预防性应用肾上腺素的效果研究摘要目的：分析经内镜逆行胰胆管造影术（EndoscopicRetrogradeCholang-iopancreatography,ERCP）术后胰腺炎（post-ERCPpancreatitis,PEP）及高淀粉酶血症

6、（Hyperamylasemia）的危险因素及研究预防性应用肾上腺素的效果。方法：本研究选取于河北医科大学第二医院在胆道微创外科2017年01月至2018年01月，术前诊断为胆总管结石行ERCP的患者，共239例符合纳入标准。设计表格，收集相关资料。最终确定ERCP术后胰腺炎及高淀粉酶发生率的相关危险因素、独立危险因素及预防性应用肾上腺素的效果。将相关危险因素进行单因素分析，对有统计学意义（P<0.05）的因素进行多因素logistic回归性分析。结果：纳入239例患者中，9例患者出现ERCP术后胰腺炎，发生率为3.76%（9例/239例），7

7、6例患者被临床诊断为ERCP术后高淀粉酶血症，发生率为31.79%（76例/239例）。PEP单因素分析取石网篮进入胰管、胆总管结石直径（≤0.6cm）、困难插管（≥10分钟）为危险因素，肾上腺素为保护性因素。PEP多因素分析取石网篮进入胰管、胆总管结石直径（≤0.6cm）为独立危险因素。ERCP术后高淀粉酶血症单因素分析性别、困难插管（≥10分钟）、操作时间（≥30分钟）为危险因素。多因素分析操作时间（≥30分钟）为独立危险因素。结论：预防应用1:10000肾上腺素为PEP保护性因素；取石网篮进入胰管、胆总管结石直径（≤0.6cm）为PEP独

8、立危险因素。手术操作时间（≥30分钟）为ERCP术后高淀粉酶血症独立危险因素。关键词：经内镜逆行胰胆管造影术,经内镜逆行胰胆管造影术后胰腺炎,高淀粉酶