摘要
目的评价直肠使用吲哚美辛栓剂预防内镜逆行胰胆管造影取石术后胰腺炎(PEP)的临床疗效,并评估不同时段给药对临床疗效的影响。方法检索PubMed、Web of Science、Cochrane图书馆、中国期刊全文数据库(CNKI)、中国生物医学文献数据库、维普、万方等数据库,并手工检索相关文献,收集直肠使用吲哚美辛栓剂预防PEP的随机对照试验,检索时间从2000年至2016年10月。以PEP发生率、出血并发症发生率为评价指标,采用Jadad评分法进行质量评估,采用Rev Man 5.3软件进行Meta分析。结果纳入符合标准的随机对照试验18项,共4 923例患者,吲哚美辛组PEP发生率低于对照组(RR=0.50,95%CI:0.42~0.60,P<0.000 01)。按不同给药时段的亚组分析中,T2组(术前0.5~1 h)、T3组(术前1~2 h)、T4组(术后0.5 h内)和T5组(术后0.5~2 h)PEP发生率均较对照组降低(分别为RR=0.38,95%CI:0.24~0.62,P<0.000 1;RR=0.43,95%CI:0.29~0.62,P<0.000 01;RR=0.52,95%CI:0.3 7~0.71,P<0.0 00 1;RR=0.39,95%CI:0.23~0.65,P=0.000 3)。T1组(术前0.5 h内)和T6组(术中给药)与对照组PEP发生率无显著差异(均P>0.05)。吲哚美辛组与对照组的出血并发症发生率无显著差异(P>0.05)。结论吲哚美辛栓剂能有效预防PEP,术前0.5~2 h和术后给药吲哚美辛均能减少PEP的发生,而无出血并发症风险的增加。
AIM To evaluate the effect of rectally administered indometacin suppository for prevention of post- endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and study the therapeutic effect of different medication administration time. METHODS Publications were searched from PubMed, Web of Science, CNKI, Cochrane Library, CBM, VIP and Wanfang database and the related literatures were searched manually. Randomized controlled trial （RCTs） of rectally administered indometacin of PEP were included. Data were collected from 2000 to October 2016. The incidence of PEP and bleeding were used as the evaluating indicators. RCTs were qualified by Jadad score and data were analyzed by RevMan 5.3. RESULTS A total of 18 RCTs involving 4 923 patients were included. The incidence rate of PEP in indometacin group was significantly lower than that in the control group （RR = 0.50, 95%CI： 0.42-0.60, P 〈 0.000 01）. As for subgroups of different administration time, the incidence rates of PEP in subgroup T2 （0.5-1 h prior to ERCP）, T3 （ 1-2 h prior to ERCP）, T4 （within 0.5 h after ERCP） and T5 （0.5-2 h after ERCP） were lower compared with the control group （RR = 0.38, 95%CI： 0.24-0.62, P〈 0.000 1; RR = 0.43, 95%CI： 0.29-0.62, P〈 0.000 01 ; RR = 0.52, 95%CI： 0.37-0.71, P〈 0.000 1; RR = 0.39, 95%CI： 0.23-0.65, P= 0.000 3, respectively）. The incidence rate of PEP had no obvious difference between the indometacin group and control group in subgroup T1 （within 0.5 h prior to ERCP） and subgroup T6 （during ERCP）. The incidence rate of bleeding had no significant difference between the indometacin group and control group （P 〉 0.05）. CONCLUSION Rectally administered indometacin suppository is effective for prevention PEP. Rectal indomethacin suppository given 0.5- 2 h before or after ERCP can protect PEP and may not increase risk of bleeding.
出处
《中国新药与临床杂志》
CSCD
北大核心
2017年第4期238-244,共7页
Chinese Journal of New Drugs and Clinical Remedies
