【摘要】：目的評價(jià)直腸使用吲哚美辛栓劑預(yù)防內(nèi)鏡逆行胰膽管造影取石術(shù)后胰腺炎(PEP)的臨床療效,并評估不同時(shí)段給藥對臨床療效的影響。方法檢索PubMed、Web of Science、Cochrane圖書館、相關(guān)期刊論文(CNKI)、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、維普、萬方等數(shù)據(jù)庫,并手工檢索相關(guān)文獻(xiàn),收集直腸使用吲哚美辛栓劑預(yù)防PEP的隨機(jī)對照試驗(yàn),檢索時(shí)間從2000年至2016年10月。以PEP發(fā)生率、出血并發(fā)癥發(fā)生率為評價(jià)指標(biāo),采用Jadad評分法進(jìn)行質(zhì)量評估,采用Rev Man 5.3軟件進(jìn)行Meta分析。結(jié)果納入符合標(biāo)準(zhǔn)的隨機(jī)對照試驗(yàn)18項(xiàng),共4 923例患者,吲哚美辛組PEP發(fā)生率低于對照組(RR=0.50,95%CI:0.42~0.60,P0.000 01)。按不同給藥時(shí)段的亞組分析中,T2組(術(shù)前0.5~1 h)、T3組(術(shù)前1~2 h)、T4組(術(shù)后0.5 h內(nèi))和T5組(術(shù)后0.5~2 h)PEP發(fā)生率均較對照組降低(分別為RR=0.38,95%CI:0.24~0.62,P0.000 1;RR=0.43,95%CI:0.29~0.62,P0.000 01;RR=0.52,95%CI:0.3 7~0.71,P0.0 00 1;RR=0.39,95%CI:0.23~0.65,P=0.000 3)。T1組(術(shù)前0.5 h內(nèi))和T6組(術(shù)中給藥)與對照組PEP發(fā)生率無顯著差異(均P0.05)。吲哚美辛組與對照組的出血并發(fā)癥發(fā)生率無顯著差異(P0.05)。結(jié)論吲哚美辛栓劑能有效預(yù)防PEP,術(shù)前0.5~2 h和術(shù)后給藥吲哚美辛均能減少PEP的發(fā)生,而無出血并發(fā)癥風(fēng)險(xiǎn)的增加。
[Abstract]:Objective to evaluate the clinical efficacy of indomethacin suppository in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) and to evaluate the effect of indomethacin suppository on the clinical efficacy. Methods PubMed,Web of Science,Cochrane library, full text database of Chinese periodicals, (CNKI), database of Chinese biomedical literature, Weipu, Wanfang and other databases were searched by hand. A randomized controlled trial of rectal indomethacin suppository for the prevention of PEP was conducted from 2000 to 2016. The incidence of PEP and the incidence of hemorrhage complications were used as the evaluation index. The quality was evaluated by Jadad scoring method and Meta analysis by Rev Man 5.3 software. Results the incidence of PEP in indomethacin group was lower than that in control group (RR=0.50,95%CI:0.42~0.60,P0.000 01). According to the subgroup analysis of different administration period, T2 group (0.5 鹵1 h), T3 group) (1 h), before operation) The incidence of h) PEP in group T4 (within 0.5 h after operation) and group T5 (0.5 h) PEP after operation) was lower than that in control group (RR=0.38,95%CI:0.24~0.62,P0.000 1, respectively). RR=0.43,95%CI:0.29~0.62,P0.000 01R RRN 0.52 / 95 CI: 0. 3 7 / 0. 71C P0.0 001; The incidence of PEP in T1 group (0.5 h before operation) and T6 group (intraoperative administration) was not significantly different from that in control group (P0.05). There was no significant difference in the incidence of hemorrhage complications between the indomethacin group and the control group (P 0.05). Conclusion Indomethacin suppository can effectively prevent the occurrence of PEP from 0.5 to 2 hours before and after the operation of PEP, without increasing the risk of bleeding complications.
【作者單位】： 暨南大學(xué)附屬第一醫(yī)院消化內(nèi)科;
【分類號】：R576

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