中药大黄经鼻空肠管和经鼻胃管辅助治疗重症急性胰腺炎疗效的Meta分析

The effect of Chinese Rhubarb by nasojejunal tube and nasogastric tube in assisting the treatment of severe acute pancreatitis： a Meta analysis

目的 通过Meta分析评价中药大黄经鼻空肠管（NJ）和经鼻胃管（NG）两种途径辅助治疗重症急性胰腺炎（SAP）的效果.方法 计算机检索Cochrane Library、PubMed、Embase、Science Citation Index Expanded-SCIE、EBSCO-CINAHL Complete、中国生物医学文献库服务系统-SinoMed、重庆维普科技期刊数据库、万方期刊全文数据库发表的有关大黄经NJ和经NG辅助治疗SAP效果的随机对照试验（RCT）.由2名研究人员按照入选标准独立筛选文献并提取研究结果资料,采用澳大利亚JBI循证卫生保健中心（2008）对RCT的评价原则进行文献质量评价,采用RevMan5.3软件对文献结果进行Meta分析.结果 共纳入11篇RCT,所有文献的质量评估均为B级.治疗后与NG组比较,NJ组的APACHE-Ⅱ评分显著下降,淀粉酶活性、CRP水平恢复正常及IL-1、IL-6下降均显著加快,肠功能恢复及腹痛缓解时间显著缩短,差异均具有统计学意义（P值均〈0.01）;但两组的并发症发生率、病死率、肠功能衰竭发生率、中转手术率和治愈率的差异均无统计学意义.结论 中药大黄经NJ灌注辅助治疗SAP能迅速缓解患者腹痛,加速肠功能的恢复,减轻炎性反应,效果显著优于经NG灌注治疗.

Objective To assess the effect of Chinese Rhubarb in assisting the treatment of severe acute pancreatitis （SAP） by nasojejunal tube （NJ） and nasogastric tube （NG）.Methods Cochrane Library, PubMed, Embase, Science Citation Index Expanded-SCIE, EBSCO-CINAHL Complete, SinoMed, VIP network and Wan Fang net were retrieved systematically and randomized controlled trails （RCT） that involved in Chinese rhubarb assisting the treatment of SAP by NJ and NG were searched.According to eligibility and extraction standards, 2 researchers independently selected relevant literature and extracted the relevant data.The quality of literature was evaluated using criteria published by Australian Evidence-Based Health Care Center （2008）.RevMan5.3 software was employed for Meta analysis.Results Eleven RCTs were enrolled and the quality of all the 11 papers was B grade.Compared with NG, NJ had lower score of APACHE-Ⅱ, shorter time of decreased CRP, amylase activity, IL-6 and IL-1, and shorter recovery time of bowel function and abdominal pain, and the differences were statistically significant （P〈0.01）.However, there were no significant differences between two groups on complication rate, mortality, the rate of bowel function failure, the rate of surgical operation and recovery rate.Conclusions Chinese Rhubarb by NJ irrigation in assisting the treatment of SAP can rapidly alleviate abdominal pain, promote bowel function recovery and reduce inflammatory reaction, which had better efficacy than NG.