Analysis Of The Risk Factors Of Post-ERCP Hyperamylasemia And The Preventive And Therapeutic Effect Of Traditional Chinese Medicine With Removing Stasis By Purgation

Objective: To investigate the risk factors of PEH after Endoscopic Retrograde Cholangio-Pancreatography(ERCP)and the preventive and therapeutic effect of TCM.Methods:The clinical data of 171 patients treated in the first affiliated hospital of dalian medical university from January 2013 to December 2017 were analyzed and analyzed according to the ERCP standard.Design table,record the basic information of the patient(gender,age,history of history of high blood pressure,diabetes,previous history of pancreatitis,cholecystectomy,ercp surgery),preoperative laboratory tests(amylase,total bilirubin),preoperative auxiliary examination results(CT,MRCP examination,abdominal ultrasound),operation records,inspection record notes and orders,postoperative blood amylase levels recorded,determine whether PEH.Through single factor analysis,the age,sex,dilation and surgery of PEH were analyzed,and the influence of PEH was analyzed.The independent risk factors of PEH were determined by multivariate Logistic regression analysis with single factor.According to different treatment methods,171 patients were divided into routine treatment group and traditional Chinese medicine group(TCM group).A total of 90 cases were treated with traditional Chinese medicine group.The serum amylase level and PEH remission time were analyzed and the differences between the two groups were analyzed.The above data were processed by SPSS17.0 statistical software.Results: Of the 171 patients who met the standard of entry,92 cases were PEH,accounting for 53.8%.Single factor analysis showed that the difficulty of intubation,some calculus not be taken as risk factors,endoscopic nasobiliary drainage(ENBD),diabetes is the protective factor;gender,age,history of hypertension,history of pancreatitis,cholecystectomy,ERCP surgery history,periampullary diverticulum,preoperative total bilirubin increased(> 19.0umol/L),common bile duct dilation(> 1cm)and endoscopic sphincterotomy(EST),endoscopic biliary stent drainage(ERBD),endoscopic papillary balloon dilation(EPBD),calculus removed and other factors were found no significant correlation.Multi factor analysis showed that difficult intubation and stones not be taken as PEH independent risk factors.Of the 171 cases,56(62.2%)were PEH in the routine group and 36(44.4%)in the combination group of traditional Chinese medicine(44.4%),and the two groups had statistical difference(P < 0.05).The level of 24 h blood amylase in the combined Chinese medicine group was lower than that of the conventional group(P<0.05).There was no significant difference in amylase remission time between the two groups(P=0.14>0.05).Conclusion: Difficult intubation and stone not be taken are independent risk factors of PEH,and ENBD and diabetes may be the protective factors.The effect of Western medicine and traditional Chinese medicine on the prevention of PEH before ERCP is better than that of Western medicine alone.Through the analysis of medical records,we can reduce the incidence of PEH by mastering the intubation technology,reducing the number of intubation,placing ENBD tube after operation and combining traditional Chinese medicine before operation.