摘要
目的评价加贝酯预防内镜逆行胰胆管造影术后胰腺炎(post-ERCP pancreatitis,PEP)的安全性和有效性。方法计算机检索Cochrane图书馆(1970～2010年12月)、PubMed(1966～2010年12月)、EMBASE(1966～2010年12月)及中国生物医学文献数据库(1978～2010年12月),查找加贝酯预防PEP的随机对照试验及其参考文献。由2名研究者独立选择试验、提取资料和评估方法学质量,采用Cochrane协作网提供的RevMan 4.2软件进行统计分析。结果共有11篇文献,包括3 012例患者纳入本研究。Meta分析结果显示:与安慰剂比较,持续(≥12 h)大剂量(≥1 000 mg)使用加贝酯可以有效预防PEP的发生(OR=0.27,95%CI为0.11～0.64,P=0.003),并可以有效预防ERCP术后腹痛的发生(OR=0.44,95%CI为0.25～0.79,P=0.005)。快速(≤6.5 h)小剂量(≤500 mg)使用加贝酯并不能有效预防PEP的发生(OR=0.85,95%CI为0.59～1.34,P=0.570),不能预防ERCP术后高淀粉酶血症的发生(OR=0.86,95%CI为0.69～1.07,P=0.180),也不能有效地预防ERCP术后腹痛的发生(OR=0.66,95%CI为0.32～1.35,P=0.250)。加贝酯组与乌司他丁组比较,2组对PEP预防效果的差异无统计学意义(OR=1.57,95%CI为0.39～6.24,P=0.520),对ERCP术后高淀粉酶血症预防效果的差异也无统计学意义(OR=1.85,95%CI为0.83～4.13,P=0.130)。结论持续(≥12 h)大剂量(≥1 000 mg)使用加贝酯能够预防PEP以及ERCP术后腹痛的发生,对于ERCP术后高淀粉酶血症的预防也有一定效果。加贝酯与乌司他丁对PEP和ERCP术后高淀粉酶血症的预防效果相同。上述结论尚需多中心、大样本和长期随访的高质量随机对照研究证实。
Objective To evaluate the effectiveness and safety of gabexate mesylate in the prevention of post-endoscopic retrograde cholangiopancreatography（ERCP） pancreatitis（PEP）.Methods The literatures and corresponding references of randomized controlled trials（RCT） on gabexate mesylate in the prevention of PEP were searched from Cochrane library（1970 to December 2010）,PubMed（1966 to December 2010）,EMBASE（1966 to December 2010）,and CBM（1978 to December 2010）.Literature screening,data extraction and methodological quality assessment were individually performed by two researchers.The software RevMan 4.2 of Cochrane Collaboration was used for statistical analysis.Results A total of 11 trails involving 3 012 patients were included.Meta analysis showed that high dose（≥1 000 mg）of gabexate mesylate with slow intravenous infusion（≥12 h） could effectively prevent from PEP（OR=0.27,95%CI： 0.11-0.64,P=0.003） and post-ERCP abdominal pain（OR=0.44,95%CI： 0.25-0.79,P=0.005） when compared with placebo.The low dose（≤500 mg） of gabexate mesylate with quick intravenous infusion（≤6.5 h） could not effectively prevent from PEP（OR=0.85,95%CI： 0.59-1.34,P=0.570）,post-ERCP hyperamylasemia（OR=0.86,95%CI： 0.69-1.07,P=0.180）,and post-ERCP abdominal pain（OR=0.66,95%CI： 0.32-1.35,P=0.250）.When compared gabexate mesylate with ulinastatin,there was no statistical difference between them in the prevention of PEP（OR=1.57,95%CI： 0.39-6.24,P=0.520） and post-ERCP hyperamylasemia（OR=1.85,95%CI： 0.83-4.13,P=0.130）.Conclusions The high dose （≥1 000 mg） of gabexate mesylate with slow intravenous infusion（≥12 h） other than low dose（≤500 mg） with quick intravenous infusion（≤6.5 h） is effective to prevent from PEP and post-ERCP abdominal pain,and can also prevent from post-ERCP hyperamylasemia to some extent.The effect which ulinastatin prevents PEP and post-ERCP hyperamylasemia is same to gabexate mesylate.The above conclusions remain to confirm b
出处
《中国普外基础与临床杂志》
CAS
2012年第1期48-57,共10页
Chinese Journal of Bases and Clinics In General Surgery
