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

Aggressive Hydration with Lactated Ringer’s Solution for Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

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。

 

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-yearold 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.