盐酸达克罗宁胶浆用于内镜逆行胰胆管造影术中不适合解痉剂患者的探讨

Application of dyclonine hydrochloride gel to patients unsuitable for antispasmodic agents during endoscopic retrograde cholangiopancreatography

摘要:

目的 评价盐酸达克罗宁胶浆在特殊人群内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）术中抑制肠蠕动的有效性和安全性。方法 选取2022年6月至2023年6月，于黑龙江省医院消化病院诊断为胆道疾病，在ERCP操作中由于频繁肠蠕动影响操作但又不适合使用解痉剂的患者72例，术中局部喷洒盐酸达克罗宁胶浆，观察给药前后十二指肠蠕动幅度和频率、镜下视野清晰度、胆管插管所需时间及生命体征等，进行用药前后自身对照，评价其有效性和安全性。另对9例疑诊奥狄括约肌运动功能障碍（sphincter of Oddi dysfunction，SOD）患者在用药前后进行奥狄括约肌压力测定（sphincter of Oddi manometry，SOM）。结果 79.2%（57/72）患者用药后十二指肠蠕动程度比用药前改善（t=22.524，P<0.05），12例气泡明显遮盖视野者用药后全部改善。63例首次ERCP患者用药后平均胆管插管成功时间（2.9±4.2）min。9例SOD患者中7例用药后括约肌基础压力和（或）收缩频率下降（χ2=5.143，P<0.05）。所有患者术中未出现药物相关并发症。ERCP术后胰腺炎及高淀粉酶血症发生率分别为4.2%（3/72）和8.3%（6/72）。结论 ERCP术中，对于因频繁肠蠕动影响操作而又不适合用解痉剂的特殊人群，局部喷洒盐酸达克罗宁胶浆可以有效抑制十二指肠蠕动，降低奥狄括约肌基础压力及收缩频率，改善操作条件，提高胆管插管成功率，并具有较好的安全性。

Abstract:

Objective To evaluate the efficacy and safety of dyclonine hydrochloride gel for patients unsuitable for antispasmodic agents during endoscopic retrograde cholangiopancreatography(ERCP). Methods A total of 72 patients diagnosed as having biliary diseases who intended to receive ERCP but were unsuitable for spasmolytic use were selected from June 2022 to June 2023 at the Digestive Hospital of Heilongjiang Provincial Hospital. Thus dyclonine hydrochloride gel was locally sprayed during the process of ERCP due to frequent intestinal peristalsis. The amplitude and frequency of duodenal peristalsis, clarity of endoscopic view, the time of biliary cannulation and vital signs were compared before and after the administration to evaluate efficacy and safety of dyclonine hydrochloride gel. At the same time, 9 patients with suspected sphincter of Oddi dysfunstion (SOD) underwent sphincter of Oddi manometry (SOM) before and after the administration. Results Among the 72 patients, 57 (79.2%) showed improvements in duodenal peristalsis after the administration (t=22.524,P<0.05). Twelve cases with significantly obstructed views due to bubbles showed complete improvement after the medication. The time for successful biliary cannulation after the administration was 2.9±4.2 minutes in 63 patients with first ERCP. Among the 9 SOD patients, 7 showed a decrease in basal pressure and (or) contraction frequency of the sphincter muscles after the administration (χ2=5.143, P<0.05). No drug‑related complication occurred during the operation in any of the patients. The incidences of post‑ERCP pancreatitis and hyperamylasemia were 4.2% (3/72) and 8.3% (6/72), respectively. Conclusion Local spray of dyclonine hydrochloride jelly can effectively suppress duodenal peristalsis, reduce basal pressure and contraction frequency of the sphincter, improve operational conditions, and increase the success rate of biliary cannulation with satisfactory safety in ERCP procedures for those who experience frequent intestinal peristalsis that may affect the procedure and are not suitable for the use of antispasmodics.