芒硝辅助治疗重症急性胰腺炎随机对照试验的系统评价

Adjuvant treatment of severe acute pancreatitis with natrii sulfas: A systematic review

目的评价芒硝外敷辅助治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的疗效。方法计算机检索Cochrane图书馆、PUBMED、EMBASE、Medline、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库中有关芒硝辅助治疗SAP疗效的随机对照试验,并手工检索相关文献。检索时限均为从建库至2014年12月,无语言和出版物限制。由两位研究者独立进行资料提取和质量评价后,采用Rev Man5.3软件进行Meta分析。结果共纳入10个随机对照试验,包括680例患者。Meta分析表明:芒硝组腹痛、腹胀缓解时间,发热时间,禁食时间,住院天数均短于对照组,差异有统计学意义(P<0.05)。芒硝组并发症发生率低于对照组,差异有统计学意义(P=0.02)。两组间死亡率差异无统计学意义(P=0.21)。结论芒硝外敷辅助治疗SAP能明显缩短患者的腹痛缓解时间、腹胀缓解时间、发热时间、禁食时间、住院时间和并发症发生率。鉴于该系统评价为二次研究,纳入分析的原始文献质量不一,而且评价过程也可能存在偏倚,上述结论尚需进一步开展大规模、高质量的基础和临床研究来验证。

Objective To assess the efficacy of natrii sulfas in the adjuvant treatment of severe acute pancreatitis.Methods Published randomized controlled trials（RCTs） of natrii sulfas in the adjuvant treatment of severe acute pancreatitis in data-base of Cochrane library,PUBMED,EMBASE,Medline,CNKI,CBM,VIP and Wanfang Data were searched from the date of establishment of the databases to December 2014.A manual search of relevant journals and conference proceedings were also performed.Two reviewers assessed the quality of each included studies according to Cochrane Reviewers＇ Handbook 4.2.2 recommend standard and then extracted data.Meta-analyses were performed with Rev Man 5.3 software.Results A total of 10 studies involving 680 cases were included into the analysis.Meta-analysis showed that the relieve time of abdominal pain and distension,the period of fever,the fasting period and the days of hospitalization stay in the patients treated with natrii sulfas were significantly shorter than that in the control groups（all P〈0.05）.The incidence of complications in the natrii sulfas group was also lower than that in the control groups（P = 0.02）.However,there was no significant difference in the rate of hospital mortality（P = 0.21）.Conclusion Adjunctive therapy of severe acute pancreatitis with natrii sulfas can decrease the incidence of complications and shorten the duration of abdominal pain and distension,the period of fever,the period of fasting and hospitalization stay.However,further large-scale and high-quality studies on basic and clinical fields are needed to verify the conclusions because that this study is a secondary study,and there are the different qualities and the bias of evaluation process in the original studies..