以積極乳酸林格氏輸液預防內視鏡逆行性膽胰管攝影術後胰臟炎發生之照護

內視鏡逆行性膽胰管攝影術（endoscopic retrograde cholangiopancreatography, ERCP）為第一線治療總膽管結石的方法，而胰臟炎為ERCP術後併發症之一。本文為一位63歲男性，因上腹痛及黃疸等症狀，診斷為總膽管結石併膽管擴張，經急診安排入院接受ERCP總膽管取石術。在ERCP術後醫師會給予病人使用乳酸林格氏輸液治療以降低術後胰臟炎風險。然而，臨床照護中對於給予乳酸林格氏輸液治療劑量不一致，造成護理人員在執行此醫囑有所疑惑，因此藉由實證方法探討ERCP術後乳酸林格氏輸液治療劑量適切。實證結果顯示積極給予乳酸林格氏輸液3c.c／kg／h於ERCP術後病人可有效預防胰臟炎的發生。在後續照護過程中，經由與醫療團隊溝通，並應用實證結果給予積極乳酸林格氏輸液治療於ERCP術後患者，住院期間未出現胰臟發炎等相關症狀。本篇僅評讀三篇文獻且針對沒有其他合併症的病人做出的照護建議，臨床照護者仍需根據病人狀況決定是否合適接受積極乳酸林格氏液治療以達到最佳ERCP術後胰臟炎預防的目的。

關鍵字

積極輸液補充；乳酸林格氏輸液；內視鏡逆行性膽胰管攝影；胰臟炎

並列摘要

Endoscopic retrograde cholangiopancreatography (ERCP) is a first-line therapy for common bile duct stones; however, post-ERCP pancreatitis is one of the procedure-related complication. This 63-year-old man presented with abdominal pain and jaundice, and was diagnosed as common bile duct stone with common bile duct dilatation. Subsequently, the patient was admitted for receiving ERCP with stone retrieval. After ERCP, Lactate Ringer's hydration as a standard prescription reduced the risk of post-ERCP pancreatitis. However, the dosage of Lactated Ringer's hydration for preventing post-ERCP remained controversial. Therefore, it is needed to perform evidence-based appraisal to investigate the adequate dosage of Lactated Ringer's hydration after ERCP. The results showed that aggressive Lactated Ringer's hydration as 3 c.c/kg/h could prevent post-ERCP pancreatitis. We applied aggressive Lactated Ringer's hydration to clinical practice after we discussed with the medical team and there was no post-ERCP pancreatitis occurred. However, there were three literatures reviewed and we provided aggressive Lactated Ringer therapy to a patient without severe comorbidities. Our experience could provide healthcare providers to provide aggressive Lactated Ringer hydration with cautions based on patients' clinical conditions in order to prevent post-ERCP pancreatitis.

並列關鍵字

aggressive hydration ； Lactated Ringer's solution ； post endoscopic retrograde cholangiopancreatography ； pancreatitis

參考文獻

游凈惠、黃鈞源、胡敏冰、鍾昀志、黃麗卿（2015）．台灣民眾血脂肪濃度與罹患膽結石症之相關性研究．台灣家庭醫學雜誌．25（2），129-137。doi:10.3966/168232812015062502003

Bhoomagoud, M., Jung, T., Atladottir, J., Kolodecik, T. R., Shugrue, C., Chaudhuri, A., ... Gorelick, F. S. (2009). Reducing extracellular pH sensitizes the acinar cell to secretagogue-induced pancreatitis responses in rats. Gas-troenterology, 137(3), 1083-1092. doi:10.1053/j.gastro.2009.05.041

Buxbaum, J., Yan, A., Yeh, K., Lane, C., Nguyen, N., & Laine, L. (2014). Aggressive hydration with lactated Ringer’s solution reduces pancreatitis after endoscopic retrograde cholangiopancreatography. Clinical Gastroenterolo-gy and Hepatology, 12(2), 303-307.e301. doi:10.1016/j.cgh.2013.07.026

Choi, J. H., Kim, H. J., Lee, B. U., Kim, T. H., & Song, I. H. (2017). Vigorous periprocedural hydration with lactated Ringer’s solution reduces the risk of pancreatitis after ret-rograde cholangiopancreatography in hospitalized patients. Clinical Gastroenterology and Hepatology, 15(1), 86-92.e1. doi:10.1016/j.cgh.2016.06.007

Chuankrerkkul, P. (2015). Mo1411 aggressive lactated Ringer’s solution for prevention of post ERCP pancreatitis (Prelim-inary Data of a Prospective Randomized Trial). Gastroin-testinal Endoscopy, 81(5), AB410-AB411. doi:10.1016/j.gie.2015.03.739

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以積極乳酸林格氏輸液預防內視鏡逆行性膽胰管攝影術後胰臟炎發生之照護

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