不同时段给药对吲哚美辛栓剂预防ERCP术后胰腺炎的作用分析  

Rectal Indomethacin for Prevention of Post-ERCP Pancreatitis

作　　者：陈小微[1] 陶丽萍[1] 金抒清[1] 陈向荣[1] 

机构地区：[1]温州医学院附属第一医院消化内科,浙江温州325000

出　　处：《中国现代应用药学》2013年第10期1135-1139,共5页Chinese Journal of Modern Applied Pharmacy

摘　　要：目的对吲哚美辛栓剂预防ERCP术后胰腺炎（post-ERCPpancreatitis，PEP）的作用，及不同给药时段对药物作用的影响进行系统性评估。方法对2000年1月-2012年12月发表的文献进行检索，纳入关于吲哚美辛栓剂预防PEP的随机对照研究（RCT），Jadad评分评估文献质量，Revman5．0软件行数据统计分析。结果按检索策略入选8个临床研究，吲哚美辛组的PEP发生相对风险率为对照组的43％（I迥=0．43，95％CI：0．32～0．58，P〈O．01）；按不同时段给药时间的亚组分析中，T1组（术前0．5～2h）和T3组（术后）中PEP发生相对风险率分别为对照组的34％（RR=0．34，95％CI：0．20-0．58）和51％（RR=O．5l，95％CI：0．34～0．75）。T2组（术前0～30min）47与对照组的PEP发生率无明显差异；吲哚美辛栓剂组中、重症PEP发生率亦明显降低（RR=0．38，95％CI：O．21～0．68）。结论吲哚美辛栓剂能有效预防PEP，术前0．5～2h和术后给药能明显降低PEP的发生率，术前30min内给药的结果尚不肯定，吲哚美辛栓剂可以有效预防术后高淀粉酶血症，减少中重症PEP发生率。OBJECTIVE To evaluate the effect of rectal indomethacin for prevention of post-ERCP pancreatitis（PEP） by Meta analysis. METHODS The papers focused on the indomethacin prevention of PEP in Jan 2000-Dec 2012 with RCT were enrolled, qualify the trials by Jadad score, and analyse data by Renman 5.0. RESULTS Eight trials were enrolled. Meta analysis results were as follows： the incidence of PEP in rectal indomethacin group versus placebo group showed a relative risk of 43%（RR=0.43, 95%CI： 0.32-0.58], P〈0.01）; as for subgroups of different medication time, the incidence of PEP in subgroup T1（0.5-2 h prior to ERCP） and subgroup T3（post-ERCP） relatively showed a significant 34%（RR=0.34, 95%CI： 0.20-0.58）and 51%（RR=0.51, 95%CI： 0.34-0.75）; there was no obvious difference in subgroup T2（within 30 min prior to ERCP）; the incidences of hyperamylasemia and mild-severe pancreatitis were both lower in indomethacin group than in control group. CONCLUSION Rectal indomethacin is effective for prevention PEP. Administration of indomethacin at 0.5-2 h prior to ERCP or post-ERCP shows a significant lower incidence of PEP, but the effect is still unsure when taken within 30 min prior to ERCP. Indomethacin also decreases the risk of hyperamylasemia and mild-severe pancreatitis.

关 键 词：吲哚美辛 ERCP术后胰腺炎 META分析 

分 类 号：R969.3[医药卫生—药理学]