保守治疗联合水溶性造影剂用于粘连性小肠梗阻有效性的Meta分析  

Therapeutic Efficacy of Conservative Treatment Combined with Water-soluble Contrast Agents for Adhesive Small Bowel Obstruction:A Meta-analysis

作　　者：李童恺 张磊[1] 郭建昇[2] LI Tongkai;ZHANG Lei;GUO Jiansheng(First Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China;Dept.of General Surgery,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西医科大学第一医院普外科,太原030001

出　　处：《中国药房》2021年第5期608-613,共6页China Pharmacy

基　　金：山西省应用基础研究计划面上自然基金资助项目(No.201901D22111204092323410051448596)。

摘　　要：目的:系统评价保守治疗联合水溶性造影剂用于粘连性小肠梗阻的有效性,为该疾病的临床用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、万方数据库、中国知网,检索时限为各数据库自建库起至2020年9月。收集在保守治疗的基础上联合水溶性造影剂用于粘连性小肠梗阻有效性的随机对照试验(RCT),筛选文献、提取数据后采用Cochrane系统评价员手册5.1.0和Jadad量表对纳入文献质量进行评价,采用Rev Man 5.3软件和Stata 16软件进行Meta分析。结果:共纳入15项研究,合计1429例患者。Meta分析结果显示,水溶性造影剂的使用显著减少了粘连性小肠梗阻患者的手术需求[OR=0.64,95%CI(0.50,0.81),P<0.001],缩短了非手术患者的缓解时间[MD=-23.37,95%CI(-32.17,-14.57),P<0.001]、住院天数[MD=-2.21,95%CI(-2.52,-1.90),P<0.001]和所有患者的总住院时间[MD=-2.43,95%CI(-3.93,-0.92),P=0.002],且不会增加并发症的发生率[OR=1.15,95%CI(0.63,2.10),P=0.65],但无法降低病死率[OR=1.26,95%CI(0.94,3.24),P=0.63]或肠切除率[OR=0.93,95%CI(0.57,1.52),P=0.78]。结论:对粘连性小肠梗阻的患者联合使用水溶性造影剂是安全、有效的,能够减少其手术需求、缩短住院时间和症状缓解时间。OBJECTIVE:To systematically evaluate the therapeutic effects of conservative treatment combined with water-soluble contrast agents for adhesive small bowel obstruction,and to provide evidence-based reference for clinical medication.METHODS:Retrieved from Cochrane library,PubMed,Embase,Wanfang database and CNKI during the inception to Sept.2020,RCTs about conservative treatment combined with water-soluble contrast agents in the therapeutic efficacy for adhesive small bowel obstruction were collected.After literature screening and data extraction,the quality of included literatures were evaluated with Cochrane system evaluator manual 5.1.0 and Jadad scale.Meta-analysis was conducted by using Rev Man 5.3 and Stata 16 software.RESULTS:A total of 15 RCTs were included,with 1429 patients in total.Results of Meta-analysis showed that the use of water-soluble contrast agents significantly reduced the surgical needs of patients with adhesive small bowel obstruction[OR=0.64,95%CI(0.50,0.81),P<0.001];reduced the remission time of non-surgical patients[MD=-23.37,95%CI(-32.17,-14.57),P<0.001],hospital stay days of non-surgical patients[MD=-2.21,95%CI(-2.52,-1.90),P<0.001]and hospital stay days of all patients[MD=-2.43,95%CI(-3.93,-0.92),P=0.002],and would not increase the incidence of complications[OR=1.15,95%CI(0.63,2.10),P=0.65],but could not reduce mortality[OR=1.26,95%CI(0.94,3.24),P=0.63]or the probability of bowel resection[OR=0.93,95%CI(0.57,1.52),P=0.78].CONCLUSIONS:The combined use of water-soluble contrast agents for patients with adhesive small bowel obstruction is safe and effective,can reduce the patient’s surgical requirements,and is beneficial to reduce the length of hospital stay and time for symptom relief.

关 键 词：粘连性小肠梗阻 水溶性造影剂 保守治疗 有效性 META分析 

分 类 号：R975.7[医药卫生—药品]