直肠使用双氯芬酸钠预防经内镜逆行胰胆管造影术后胰腺炎的Meta分析  

Meta-analysis on rectal administration of diclofenac sodium suppository for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

作　　者：赖仕勋 熊瑶[1] 冯淑芬[1] 韦宏成[1] LAI Shi-xun;XIONG Yao;FENG Shu-fen;WEI Hong-cheng(Department of C.astroenterology,the First Affiliated Hospital of Jinan University,Guangzhou 510630,Guangdong,CHINA)

机构地区：[1]暨南大学附属第一医院消化科,广东广州510630

出　　处：《海南医学》2018年第15期2183-2187,共5页Hainan Medical Journal

摘　　要：目的评价直肠使用双氯芬酸钠栓剂预防经内镜逆行胰胆管造影术后胰腺炎(PEP)的临床疗效,并评价不同给药时段对临床疗效的影响。方法检索Pub Med、Web of Science、Cochrane图书馆、EMBASE、CNKI、维普、万方数据库,收集所有直肠使用双氯芬酸钠栓剂预防PEP的随机对照试验(RCT),检索时限为1970年至2017年10月。由两位研究人员单独挑选RCT、提取数据、评估方法学质量,运用Rev Man5.3软件进行Meta分析,χ~2检验用于所纳入随机对照试验的异质性分析,漏斗图用于评估发表偏倚情况。结果共纳入11篇共1 838例患者。双氯芬酸钠组预防PEP(OR=0.31,95%CI:0.22~0.44)、高淀粉酶血症(OR=0.57,95%CI:0.35~0.93)、术后疼痛(OR=0.24,95%CI:0.11~0.54)的效果皆优于对照组,差异均有统计学意义(P<0.05)。对于不同给药时段的亚组分析,T1组(术前)和T2组(术后)PEP发病率均低于对照组(分别为OR=0.21,95%CI:0.12~0.39;OR=0.39,95%CI:0.25~0.59),差异均有显著统计学意义(P<0.01)。基于直肠给药双氯芬酸钠栓剂预防PEP的漏斗图欠对称,表明存在一定程度的发表偏倚。结论双氯芬酸钠栓剂可有效地预防PEP、高淀粉酶血症及术后疼痛。Objective To evaluate the effect of rectally administered diclofenac sodium suppository for prevention of post-endoscopic retrograde cholangiopancreatography（ERCP） pancreatitis（PEP） and study the effect of different administration time on the therapeutic effect. Methods Publications were searched from Pub Med, Web of Science, Cochrane Library, EMBASE, CNKI, VIP and Wanfang database, and all randomized controlled trials of rectal administration of diclofenac sodium suppository for prevention of PEP were included. Data were collected from 1970 to October2017. Two researchers selected RCTs, extracted data, and evaluated methodological quality independently, and Rev Man5.3 software was used for the meta-analysis. The chi-square test was used for the heterogeneity analysis of RCTs included, and the funnel plots were used to evaluate publication bias. Results A total of 11 RCTs involving 1 838 patients were included. Compared with the placebo, diclofenac sodium had significantly better effects in preventing PEP（OR=0.31, 95%CI： 0.22-0.44）, hyperamylasemia（OR=0.57, 95%CI： 0.35-0.93）, and abdominal pain（OR=0.24, 95%CI： 0.11~0.54）, all P〈0.05. As for subgroups of different administration time, the incidence rates of PEP in subgroup T1（before ERCP） and T2（after ERCP） were lower compared with the control group（OR=0.21, 95%CI： 0.12-0.39; OR=0.39, 95%CI： 0.25-0.59）. The funnel plots based on the effect of rectal administration of diclofenac sodium suppository in preventing PEP were slightly asymmetric, which suggested the presence of publication bias. Conclusion Diclofenac sodium suppository can effectively prevent PEP, hyperlipidemia, and abdominal pain.

关 键 词：双氯芬酸钠 经内镜逆行胰胆管造影术 胰腺炎 

分 类 号：R657.51[医药卫生—外科学]