University of Helsinki, Helsinki, Finland.
Department of Anesthesia and Intensive Care Medicine, South Karelia Central Hospital, Lappeenranta, Finland.
Scand J Surg. 2020 Jun;109(2):115-120. doi: 10.1177/1457496918822616. Epub 2019 Jan 17.
Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests.
A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation.
Multivariate analysis showed post-endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p < 0.001). Incidence of other adverse effects was too low for statistical analysis.
Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient's individual needs.
多项研究和指南对手术和内镜操作中的常规术前实验室检查提出了质疑。目前尚不清楚这些检查在逆行胰胆管造影术中的效果。本研究旨在评估逆行胰胆管造影术不良事件的风险及其与术前实验室检查的关系。
这是一项于 2012 年 3 月 1 日至 2013 年 2 月 28 日在赫尔辛基大学中心医院内镜科进行的单中心前瞻性观察性研究，共纳入 956 例接受 1196 例逆行胰胆管造影术的患者。分析了所有患者的术前常规实验室检查结果（基本血常规、肌酐、钾、钠、国际标准化比值/凝血酶时间、淀粉酶）、健康状况、用药情况和人口统计学资料，以了解与逆行胰胆管造影术和程序镇静相关的不良事件。
多变量分析显示，术后胰腺炎（43 例，3.6%）与常规术前实验室检查异常无关。镇静引起的呼吸抑制（128 例，11%）与常规术前实验室检查异常无关，贫血被认为是一种轻微的保护因素。镇静引起的心血管抑制与血小板减少症相关（比值比=1.87，p=0.025），且在男性患者中，与低钠血症相关（比值比=3.66，p<0.001）。其他不良事件的发生率太低，无法进行统计学分析。
常规的术前实验室检查未能成功预测逆行胰胆管造影术不良事件。实验室检查应根据每个患者的个体需求进行。
