To evaluate the effectiveness of thoracic epidural analgesia (TEA) for prevention of post-ERCP pancreatitis (PEP). Materials and methods. Between 2015 and 2019, a randomized study of the results of endoscopic treatment in 491 patients was conducted. The first group of patients (N=247) received thoracic epidural analgesia during ERCP procedures, the patients of the second group (N=244) received a narcotic analgesic. Results. In the first (TEA) group there were no cases of pancreatic necrosis and fatal outcome, in the second (control) group in 7 (2.9%) patients were diagnosed with this adverse event, of which 3 (1.2%) patients died. A statistically significant reduction in the incidence of PEP was found due to the use of epidural analgesia in all age categories (p = 0.0004-0.0232), in women (p = 0.0000) and men (p = 0.0057), patients with jaundice (p = 0.0000), with sphincter of Oddi dysfunction (p = 0.0000), with common bile duct stones (p = 0.0004), with tumor (p = 0.0010), after biliary sphincterotomy (p = 0.0000), biliary-stone extraction (p = 0.0013), nasobiliary drainage (p = 0.0016). The study has proved the effectiveness of thoracic epidural analgesia in patients with high risk of post-ERCP pancreatitis (p = 0.0000). Conclusion. The use of thoracic epidural analgesia during therapeutic ERCP procedures is an effective method of preventing post-ERCP pancreatitis. K E Y w O R D S-therapeutic ERCP, prevention of post-ERCP pancreatitis, thoracic epidural analgesia.
Aim. To determine the value of concomitant non-alcoholic fatty liver disease in patients with arterial hypertension in the progression of rigidity of the main arteries and in increase of risk of cardiovascular complications. Material and methods. A cross-sectional comparative study was conducted. Group 1 (n=50, 35(70%) women, average age 57,4±6,9 years) included patients with arterial hypertension and non-alcoholic fatty liver disease, group 2 (n=50, 40(80%) women, average age 56,5±7,0 years) included patients with arterial hypertension only. The groups were comparable in the main clinical and demographic indicators (p>0,05). A comparative analysis of pulse wave velocity, central aortic pressure, vascular age and a 10-year risk of developing cardiovascular complications in both groups was performed.Results. There is a statistically larger number of patients with metabolic index>7,0 (58,0% vs 28,0%, p=0,0019). It was also established that systolic (121,9±10,9 mm Hg vs 115,9±8,9 mm Hg) and diastolic (82,5±9,3 mm Hg vs 77,4±8,9 mm Hg) aortic pressure, as well as the augmentation index (26,5±8,5% vs 18,6±4,2%), were significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension. In the 1st group, a statistically significant increased pulse wave velocity was found both in muscular (12,0±3,1 m/s vs 10,6±1,8 m/s) and elastic (10,4±2,8 m/s vs 9,1±1,7 m/s) vessels, which indicates an increase in arterial stiffness. In addition, there was an increase in post-occlusal pulse wave velocity in this category of patients (11,0±3,3 m/s vs 9,4±1,9 m/s, p=0,0037). A significant increase in vascular age in relation to the passport age (60,4 [56,0:68,0] years vs 58,0 [53,0:60,0] years) and an increase in the 10-year fatal risk was detected (2,15 [1,42: 4,63] and 1,05 [0,52: 2,82] %, p = 0,0043 ) were also revealed in patients with arterial hypertension and non-alcoholic fatty liver disease compared to patients with isolated arterial hypertension. Significantly more patients with a high (13 (26,0%) vs 5 (10,0%), p = 0,0332) total cardiovascular risk were observed in group 1 than in group 2.Conclusions. Arterial stiffness was significantly higher in patients with arterial hypertension and non-alcoholic fatty liver disease than in patients with isolated arterial hypertension, which is confirmed by a statistically significant increase in pulse wave velocity and central aortic pressure. Comorbid patients have pronounced endothelial dysfunction, which is confirmed by a significant increase in the post-occlusion rate of the pulse wave. An increase in vascular age in relation to the passport age indicates earlier aging of blood vessels in the 1st group compared with the 2nd group. Patients in the main group have a higher incidence of a high 10-year risk of developing cardiovascular events compared with patients in the control group.
TEA is effective and justified preventive method in patients with high risk of postoperative pancreatitis. In low risk patients use of indomethacin per rectum is preferred compared with TEA due to its invasiveness.
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