| 摘要: |
| 目的 系统评价中药高位保留灌肠预防内镜逆行胰胆管造影术后胰腺炎(PEP)的疗效和安全性。方法:计算机检索PubMed、The Cochrane Library、EMbase、中国知网、维普数据库、万方数据库、中国生物医学文献服务系统数据库，搜集关于中药高位保留灌肠预防PEP疗效和安全性的随机对照试验(RCT)，检索时限均从建库至2022年12月9日。由2名研究者独立进行文献的筛选、资料的提取及偏倚风险的评估，通过Stata 15软件进行数据分析。结果:纳入的6项RCTs共包含样本量579例。Meta分析显示，与西医常规治疗相比，中药高位保留灌肠可以降低PEP发生率(OR=0.27，95%CI[0.13，0.54]，P＜0.001)、内镜逆行胰胆管造影术后高淀粉酶血症(PEH)发生率(OR=0.29，95%CI[0.19，0.44]，P＜0.001)，降低术后3 h(SMD=-0.51，95%CI[-0.85，-0.17]，P=0.003)、6 h(SMD =-1.15，95%CI[-1.72，-0.59]，P＜0.001)、12 h(SMD=-0.69，95%CI[-0.98，-0.40]，P=0.003)、24 h(SMD =-1.91，95%CI[-3.16，-0.66]，P=0.003)血清淀粉酶(AMS)水平，降低术后24 h血清白细胞介素-6(IL-6)水平(SMD =-1.26，95%CI[-1.61，-0.91]，P＜0.001)，缩短住院时间(SMD=-1.13，95%CI[-1.70，-0.56]，P＜0.001)，节约住院费用(SMD=-0.41，95%CI[-0.75，-0.07]，P=0.017)。结论:中药高位保留灌肠在预防PEP方面总体疗效显著，具有良好的安全性，同时还能缩短住院时间并减少住院成本。 |
| 关键词: 内镜逆行胰胆管造影 胰腺炎 灌肠 Meta分析 |
| DOI：10.3969/j.issn.1007-6948.2023.05.006 |
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| 基金项目:北京市科技计划项目(Z161100000516058)；第四批全国中医(临床、基础)优秀人才研修项目(国中医药人教发[2017]24号) |
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| High retention enema with traditional Chinese medicine for post-ERCP pancreatitis: a Meta-analysis |
| GAO Xia，WANG Lin-heng，MENG Jie |
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| Abstract: |
| Objective This study systematically evaluated the efficacy and safety of high retention enema with traditional Chinese medicine(TCM) for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP). Methods The PubMed, The Cochrane Library, EMbase, CNKI, VIP, WanFang and SinoMed database were retrieved from the time of database establishment to December 9, 2022 to collect randomized controlled trials (RCTS) on the efficacy and safety of high retention enema with TCM for preventing PEP. According to the inclusion and exclusion criteria, two researchers independently conducted literature screening, data extraction and bias risk assessment, and then the meta -analysis was conducted with Stata15 software. Results A total of 6 RCTs involving 579 patients were included. The results of meta-analysis showed that, compared with routine Western medicine treatment, high retention enema with TCM could reduce the incidence of PEP(OR=0.27，95%CI[0.13，0.54]，P＜0.001) and post-ERCP hyperamylasemia(PEH)(OR=0.29，95%CI[0.19，0.44]，P＜0.001), decrease the level of amylase (AMS) at 3 hours(SMD=-0.51，95%CI[-0.85，-0.17]，P=0.003), 6 hours(SMD =-1.15，95%CI[-1.72，-0.59]，P＜0.001), 12 hours(SMD =-0.69，95%CI[-0.98，-0.40]，P=0.003) and 24 hours(SMD =-1.91，95%CI[-3.16，-0.66]，P=0.003) after ERCP, decrease the level of interleukin-6(IL-6) at 24 hours after operation(SMD =-1.26，95%CI[-1.61，-0.91]，P＜0.001), shorten the hospitalization time(SMD =-1.13，95%CI[-1.70，-0.56]，P＜0.001) and save the hospitalization expenses(SMD =-0.41，95%CI[-0.75，-0.07]，P=0.017). Conclusions High retention enema with TCM was effective and safe in preventing PEP, and it could shorten the hospitalization time and reduce the hospitalization cost. Influenced by the quality of included literature, the above conclusions need to be verified by more high-quality clinical studies. |
| Key words: Endoscopic retrograde cholangiopancreatography pancreatitis enema Meta-analysis |
