大黄灌胃灌肠联合芒硝外敷对重症急性胰腺炎临床疗效的Meta分析

Clinical effect of rhubarb combined with mirabilite on severe acute pancreatitis:A Meta-analysis

[目的]用循证医学的方法评价大黄灌胃灌肠联合芒硝外敷辅助治疗重症急性胰腺炎的疗效。[方法]计算机检索2004-03—2014-04期间中国知网、重庆维普、万方、PubMed、OVID、Elsevier Science Direct电子数据库的相关随机对照临床试验。由2位研究者按照纳入与排除标准独立筛选文献并提取资料和评价纳入研究的方法学质量后,应用RevMan5.2统计软件进行Meta分析。[结果]大黄灌胃灌肠联合芒硝外敷辅助治疗重症急性胰腺炎治疗组的首次排便时间[MD=-1.73,95%CI(-2.15,-1.31),P<0.00001]、腹痛缓解时间[MD=-1.86,95%CI(-2.51,-1.21),P<0.00001]、腹胀缓解时间[MD=-2.22,95%CI(-2.81,-1.63),P<0.00001]、平均住院天数[MD=-6.18,95%CI(-7.86,-4.50),P<0.00001]、并发症发生率[RR=0.42,95%CI(0.27,0.65),P<0.0001]、病死率[RR=0.44,95%CI(0.24,0.83),P=0.01]均明显低于对照组,差异有统计学意义。[结论]中药大黄灌胃灌肠联合芒硝外敷辅助治疗重症急性胰腺炎能显著缩短重症急性胰腺炎患者的首次排便时间、腹痛缓解时间、腹胀缓解时间、平均住院天数,同时明显降低并发症发生率和病死率。

[Objective]To evaluate the effectiveness of rhubarb combined with mirabilite in the treatment of severe acute pancreatitis according to a Meta‐Analysis.[Methods]Relevant randomized controlled clinical trials （RCTs ） were collected by retrieving the relevant articles published on CNKI ,VIP ,WanFang , PubMed ,OVID ,Elsevier ScienceDirect electronic databases from March of 2004 to April of 2014.Two reviewers independently screened studies according to inclusion and exclusion criteria ,extracted data and assessed quality of the included studies.Then metaanalysis was performed by using RevMan 5.2 software.[Results]Compared with the control group ,patients treated with rhubarb and mirabilite showed significantly lower time of the first defecation time（MD= -1.73 ,95% CI-2.15 to -1.31 ,P〈0.00001） ,shorter abdominal pain relief time（MD= -1.86 ,95% CI-2.51 to -1.21 ,P〈0.00001） ,shorter abdominal distension relief time（MD= -2.22 ,95% CI-2.81 to -1.63 ,P〈0.00001） ,less average hospitalization days（MD= -6.18 ,95% CI-7.86 to -4.50 ,P〈0.00001） ,lower the incidence of complications （RR=0.42 ,95% CI 0.27 to 0.65 ,P〈0.0001）and lower hospital mortality （RR=0.44 ,95% C10.24 to 0.83 ,P=0.01）.[Conclusion] The combination therapy with rhubarb and mirabilite on severe acute pancreatitis can significantly shorten the first defecation time ,abdominal distension relieve time ,abdominal pain relief time ,average hospitalizaion days ,and can significantly reduce the incidence of complications and hospital mortality.Due to the limited quality and quantity of the inclusion studies ,more high quality studies with larger sample size are needed to verify the above conclusion.