生长抑素治疗肠梗阻效果的系统评价

Stilamin for intestinal obstruction:A systematic review of efficacy

目的:评价生长抑素治疗肠梗阻的临床疗效.方法:计算机检索Cochrane Library、PubMed、Embase、SCI、CNKI、CBM、VIP、WANFANG DATA,纳入生长抑素结合常规治疗与常规治疗比较用于肠梗阻的随机对照试验和半随机对照试验,对纳入研究的方法学质量进行评价,用Cochrane协作网提供的软件RevMan5.1对数据进行统计分析,并对统计结果进行系统评价.结果:共纳入13个研究,共计852例患者.Meta分析结果显示:生长抑素结合常规治疗在以下方面均优于常规治疗,差异具有统计学意义.(1)腹痛消失时间:MD=-2.96,95%CI:(-4.08,-1.84);(2)腹胀消失时间:MD=-2.9895%CI:(-4.33,-1.63);(3)肛门恢复排气时间:MD=-4.69,95%CI:(-5.24,-4.13);(4)腹痛腹胀缓解率:根据治疗周期不同进行亚组分析治疗48h及疗程结束后腹痛腹胀缓解率均具有统计学意义:RR=1.23,95%CI:(1.08,1.42);RR=1.51,95%CI:(1.29,1.76);(5)肛门恢复排气排便率:根据治疗周期不同进行亚组分析治疗48h及疗程结束后肛门恢复排气排便率均具有统计学意义:RR=1.20,95%CI:(1.041.37);RR=1.71,95%CI:(1.35,2.17);(6)平均住院时间:MD=-5.09,95%CI:(-5.95,-4.22);(7)中转手术率:RR=0.33,95%CI:(0.210.52);(8)胃肠减压量:根据治疗周期不同进行亚组分析,治疗48、72h及疗程结束后胃肠减压量均具有统计学意义:MD=-305.4395%CI:(-359.84,-251.03);MD=-345.8095%CI:(-406.63,-284.97);MD=-507.1495%CI:(-549.19,-465.09).结论:目前研究表明生长抑素结合常规治疗肠梗阻的疗效明显优于常规治疗,但纳入的样本量小并且质量不高,因此,有必要开展更多高质量、多中心的随机双盲对照试验进一步证实其疗效.

AIM：To assess the efficacy of Stilamin for intestinal obstruction. METHODS：Cochrane Library, PubMed, Em-base, SCI, CNKI, CBM, VIP and WANFANG databases were searched to identify randomized controlled trials and quasi-randomized controlled trials of Stilamin combined with conventional therapy versus conventional therapy for intestinal obstruction. The data were analyzed using the RevMan 5.1 software. RESULTS：Thirteen studies（852 patients） were enrolled. The results of meta-analysis showed that there is a significant difference between the group of Stilamin combined with conventional therapy and the group of conventional therapy in：（1） time to relief of abdominal pain：MD = -2.96, 95% CI：（-4.08, -1.84）; （2） time to relief of abdominal distention：MD = -2.98, 95% CI：（-4.33, -1.63）; （3） time required for restoration of anus exhaust：MD = -4.69, 95% CI：（-5.24, -4.13）; （4） rate of remission of abdominal pain and abdominal distention：according to the treatment cycle of different subgroups, there is a statistical significance among different subgroups for 48 h after treatment and at the end of treatment：RR = 1.23, 95% CI：（1.08, 1.42）; RR = 1.51, 95% CI：（1.29, 1.76）; （5） rate of restoration of anus exhaust：according to the treatment cycle of different subgroups, there is a statistical significance for 48 h post-treatment and at the end of the treatment：RR = 1.20, 95% CI：（1.04, 1.37）, RR = 1.71, 95% CI：（1.35, 2.17）; （6） mean hospitalization stay：MD = -5.09, 95% CI：（-5.95, -4.22）; （7） rate of conversion to operation：RR = 0.33, 95% CI：（0.21, 0.52）; and （8） amount of gastrointestinal decompression：according to the treatment cycle of different subgroups, there is a statistical significance for 48 h, 72 h post-treatment and at the end of the treat- ment：MD = -305.43, 95% CI：（-359.84, -251.03）; MD = -345.80, 95% CI：（-406.63, -284.97）; MD = -507.14, 95% CI：（-549.19, -465.09）. CONCLUSION：Current evidence suggests that Stilamin combined with conventional therapy is superior to the conventional therapy for intestinal obstruction. However, large-scale, highquality, double-blinded RCTs are required to confirm the efficacy.