本文選題：經(jīng)內(nèi)鏡胰膽管造影術(shù) + 硝酸甘油　； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:評估硝酸甘油是否可預(yù)防經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎(post-endoscopic retrograde cholangiopancreatography pancreatitis,PEP),為臨床預(yù)防經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎的發(fā)生提供一定參考。方法:基于研究主題制定檢索策略,由兩名研究人員獨立通過計算機在以下數(shù)據(jù)庫中檢索有關(guān)硝酸甘油預(yù)防PEP的臨床文獻:Pubmed、Embase、the Cochrane library、SCI、Web of science、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(CBM)、中國知網(wǎng)數(shù)據(jù)庫(CNKI)及萬方數(shù)據(jù)庫,文種限定中英文,檢索時限均從建庫至2016年11月30日。按照納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)篩選文獻,對最終納入的文獻進行數(shù)據(jù)提取,通過Cochrane協(xié)作網(wǎng)的偏倚風(fēng)險評價表進行質(zhì)量評價,采用Rev Man 5.3軟件進行數(shù)據(jù)整合分析。因納入的各項研究間硝酸甘油的給藥途徑、劑量及PEP嚴重程度、研究地域不同,為探討臨床異質(zhì)性行亞組分析。為驗證結(jié)局的穩(wěn)定性及可靠性,行發(fā)表偏倚及敏感性分析。結(jié)果:納入13篇共計2695例行經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)(endoscopic retrograde cholangiopancreatography,ERCP)患者(硝酸甘油組1339例,對照組1356例)的臨床文獻,薈萃分析示硝酸甘油可降低ERCP術(shù)后胰腺炎的發(fā)生率[RR=0.62,95%CI(0.48-0.80,P=0.0002]。亞組分析結(jié)果示(1)ERCP術(shù)后胰腺炎嚴重程度分型。輕度胰腺炎組:納入6項研究,共1809例行ERCP患者(硝酸甘油組899例,對照組910例),分析結(jié)果示硝酸甘油降低輕度ERCP術(shù)后胰腺炎的發(fā)生無統(tǒng)計學(xué)意義[RR=0.77,95%CI(0.52-1.15),P=0.20]。中重度胰腺炎組:納入5項,共1621例行ERCP患者(硝酸甘油組805例,對照組816例),分析結(jié)果示硝酸甘油降低中重度ERCP術(shù)后胰腺炎的發(fā)生無統(tǒng)計學(xué)意義[RR=0.70,95%CI(0.42-1.15),P=0.16];(2)按給藥途徑分型:舌下含服可降低PEP的發(fā)生[RR=0.40,95%CI(0.25-0.63),P0.0001]。透皮貼劑、局部噴灑組預(yù)防PEP的發(fā)生無統(tǒng)計學(xué)意義([RR1=0.78,95%CI1(0.55-1.10),P1=0.16];[RR_2=1.00,95%CI2(0.28-3.53),P2=1.00]);(3)用藥劑量分型:小于5mg組可降低PEP的發(fā)生[RR=0.50,95%CI(0.33-0.78),P=0.002]。5-10mg組及15mg組降低ERCP術(shù)后胰腺炎的發(fā)生無統(tǒng)計學(xué)意義([RR1=0.73,95%CI1(0.48-1.11),P1=0.14];[RR_2=0.64,95%CI2(0.41-1.02),P2=0.06]);(4)地域分型:硝酸甘油降低PEP發(fā)生率在亞歐地區(qū)有統(tǒng)計學(xué)意義([RR1=0.52,95%CI1(0.33-0.79),P1=0.003;RR_2=0.56,95%CI2(0.39-0.81),P2=0.002])。結(jié)論:硝酸甘油可預(yù)防經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎的發(fā)生,本研究最佳給藥途徑為舌下含服,其主要副反應(yīng)為低血壓、頭痛,經(jīng)常規(guī)治療后可好轉(zhuǎn)。
[Abstract]:Objective: to evaluate whether nitroglycerin can prevent post-endoscopic retrograde cholangiopancreatography pancreatitis after endoscopic retrograde cholangiopancreatography. Methods: based on the research topic, the retrieval strategy was established. Two researchers independently searched the following databases: the clinical literature on nitroglycerin prevention of PEP:: Pubmed Embase, the Cochrane library of science, the Chinese biomedical literature database, CNKI) and Wanfang database, in English and Chinese, respectively. The time limit for retrieval is from the construction of the database to November 30, 2016. According to the inclusion criteria and exclusion criteria, the data were extracted and evaluated by the bias risk evaluation table of Cochrane cooperation network, and the data integration analysis was carried out by Rev Man 5.3 software. Subgroup analysis was carried out to explore clinical heterogeneity due to the study of the route, dosage and PEP severity of m-nitroglycerin in different study areas. To verify the stability and reliability of the outcome, publication bias and sensitivity analysis were performed. Results: a total of 2695 patients (1339 patients in nitroglycerin group and 1356 patients in control group) underwent endoscopic retrograde cholangiopancreatography (ERCP). The meta-analysis showed that nitroglycerin could reduce the incidence of pancreatitis after ERCP [RRN 0.62N 95 CI 0.48-0.80P0.0002]. The results of subgroup analysis showed the severity of pancreatitis after ERCP. Mild pancreatitis group: a total of 1809 ERCP patients (nitroglycerin group, 899 cases, control group, 910 cases) were included in 6 studies. The results showed that nitroglycerin decreased the incidence of pancreatitis after mild ERCP. In the moderate and severe pancreatitis group, 1621 patients with ERCP were included in 5 items (805 patients in nitroglycerin group). In the control group (816 cases), the results showed that nitroglycerin decreased the incidence of pancreatitis after moderate and severe ERCP. There was no significant difference in the incidence of pancreatitis after operation [RRN 0.70 ~ 95 CI: 0.42-1.15 ~ (0.16) P ~ (0. 16)] according to the way of administration: sublingual administration could reduce the incidence of PEP [RRN 0.4025 ~ (0.63) P 0.0001]. Transdermal patch, 灞，

本文編號：1801212