围手术期大剂量补充乳酸林格液预防和减轻ERCP术后胰腺炎的荟萃分析  

Peri-procedural large-dose lactated Ringer solution in prevention and alleviation of post-ERCP pancreatitis:a meta-analysis

作　　者：李星志 吴长伟 任笠坤 刘浩 韩民 Li Xingzhi;Wu Changwei;Ren Likun;Liu Hao;Han Min(Clinical Medical College,Guizhou Medical University,Guiyang 550004,China;Department of Hepatobiliary Surgery,First People Hospital of Bijie,Bijie 551700,Guizhou Province,China;Department of Hepatobiliary Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学临床医学院,贵阳550004 [2]贵州省毕节市第一人民医院肝胆外科,551700 [3]贵州医科大学附属医院肝胆外科,贵阳550004

出　　处：《中华肝胆外科杂志》2020年第11期839-845,共7页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的:系统评价围手术期不同补液方案下积极补充乳酸林格液(LRS)预防和减轻内镜逆行胰胆管造影术后胰腺炎(PEP)的作用与安全性,分析精准量化的补液方案。方法:计算机检索PubMed、Embase、Cochrane Library、万方数据库、中国期刊全文数据库、维普数据库自建库至2020年2月的文献,收集不同补液方案的LRS预防和减轻PEP的随机对照研究,试验组围手术期予以LRS积极补液,补液量明显高于对照组,对照组予以标准剂量LRS或生理盐水补液。由2名研究员根据纳入及排除标准独立筛选文献、提取资料以及评估偏倚风险,RevMan 5.3软件用于统计分析。结果:最终纳入10篇文献,包括2 261例患者,试验组1 140例,对照组1 121例。荟萃分析结果,试验组在围手术期总补液时长约9 h内以5.0 ml·kg -1·h -1的速度补液,与对照组比较,试验组PEP发生率明显降低,差异有统计学意义( OR=0.32,95% CI:0.21~0.48, P<0.05),中重度PEP发生率也明显降低,差异有统计学意义( OR=0.28,95% CI:0.09~0.84, P<0.05)。而不增加补液相关不良反应发生率。但是在9 h内以4.0~4.5 ml·kg -1·h -1的速度补液以及在总补液时长约24 h内以小于4.0 ml·kg -1·h -1的速度补液时,两组间PEP发生率、中重度PEP发生率差异无统计学意义(均 P>0.05)。 结论:围手术期约9 h内以5.0 ml·kg -1·h -1的速度补充LRS是当前证据下预防和减轻PEP的最合理的补液方案,推荐临床应用以及值得进一步研究。Objective To study the effectiveness and safety of perioperative lactated Ringer solution(LRS)in prevention and alleviation of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)under different fluid replacement regimens to arrive at the most precise quantitative fluid replacement regimen.Methods Pubmed,Embase,Cochrane Library Database,Wanfang Database,CNKI,and VIP were searched from inception to February 2020.Randomized controlled trials on LRS in prevention and alleviation of PEP under different fluid replacement regimens were collected.The experiment group was actively rehydrated with LRS during the perioperative period,and the amount of rehydration was significantly higher than that of the control group.The control group was given standard dose of LRS or normal saline.Two researchers independently selected the articles based on predetermined inclusion and exclusion criteria,extracted the data,and evaluated the risk of bias.RevMan 5.3 software was used for statistical analysis.Results Ten studies with 2261 patients were included,with 1140 patients in the experiment group,and 1121 patients in the control group.Meta-analysis showed that when the experiment group was given LRS at a rate of 5.0 ml·kg-1·h-1 during the perioperative period for about 9 hours and compared with the control group,the incidence of PEP in the experiment group was significantly reduced(OR=0.32,95%CI:0.21-0.48,P<0.05).The incidence of moderate to severe PEP was also significantly reduced(OR=0.28,95%CI:0.09-0.84,P<0.05).There was no increase in the incidence of adverse reactions related to fluid replacement.However,there were no significant differences in the incidence of PEP,and in moderate to severe PEP between the two groups when LRS was given at a rate of 4.0~4.5 ml·kg-1·h-1 within 9 hours,and less than 4.0 ml·kg-1·h-1 within 24 hours of total rehydration time(all P>0.05).Conclusion During the perioperative period,the current evidence showed that it is most reasonable to give the fluid replacement regimen with agg

关 键 词：胰腺炎 大剂量 内镜逆行胰胆管造影 乳酸林格液 荟萃分析 

分 类 号：R576[医药卫生—消化系统]