胃镜下电凝止血联合蒙脱石散创面给药治疗胃溃疡出血的临床疗效及安全性评价

The evaluation of clinical efficacy and safety of endoscopic electrocoagulation combined with Montmorillonite powder on gastric ulcer bleeding

目的系统评价胃镜下电凝止血联合蒙脱石散创面给药治疗胃溃疡出血的临床疗效和安全性。方法计算机检索Pub Med、EBSCO、the Cochrane Library、Web of Science、CBM、CNKI、VIP、Wan Fang,收集有关胃镜电凝止血联合蒙脱石散治疗胃溃疡出血的随机对照试验(RCTs),根据Cochrane协作网系统评价的方法分析纳入文献,采用Rev Man 5.3软件进行Meta分析。结果共纳入11项研究(986例患者),Meta分析结果显示,胃镜电凝止血联合蒙脱石散创面给药优于单用胃镜电凝止血:总有效率(OR=4.83,95%CI:2.97~7.85,Z=6.34,P<0.00001)、4周后溃疡愈合率(OR=3.48,95%CI:2.02~6.01,Z=4.48,P<0.00001)、总输血量(MD=-233.76,95%CI:-244.89^-222.64,P<0.00001)、止血时间(MD=-1.87,95%CI:-2.08^-1.66,P<0.00001)、住院时间(MD=-5.61,95%CI:-6.30^-4.92,P<0.00001)、再出血率(OR=0.24,95%CI:0.13~0.44,Z=4.59,P<0.00001)、手术治愈率(OR=0.19,95%CI:0.09~0.39,Z=4.49,P<0.00001),不良反应(恶心、呕吐、便秘)差异无统计学意义(OR=1.44,95%CI:0.56~3.71,Z=0.75,P>0.05)。结论胃镜下电凝止血联合蒙脱石散创面给药治疗胃溃疡出血的疗效优于单用胃镜电凝止血,再出血率及手术治愈率降低,值得在临床上推广使用。

Objective To evaluate the clinical efficacy and safety of endoscopic electrocoagulation combined with Montmorillonite powder on gastric ulcer bleeding. Methods Randomized controlled trials （RCTs） of endoscopic electrocoagulation combined with Montmorillonite powder in the treatment of gastric ulcer bleeding were researched on PubMed database, EBSCO database, the Coehrane Library, Web of Science database, CBM, CNKI, VIP, WanFang. The methodological quality of RCTs was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. Results A total of 11 studies involved 986 patients were included. The clinical results of the experimental group were better than those in control group in that aspects as follows ： the total effective rate （ OR = 4.83, 95% CI： 2.97-7.85, Z=6.34, P〈0.00001）, the ulcer healing rate4 weeks lately （OR=-3.48, 95% CI： 2.02- 6. 01, Z = 4.48, P 〈 0. 00001 ）, the total volume of blood transfusion （MD = -233.76, 95 % CI： -244.89 - -222.64, P〈0.00001）, hemostasis time （MD = -1.87, 95% CI： -2.08- -1.66, P 〈0.00001）, hospital time （MD = -5.61, 95% CI： -6.30- -4.92, P〈0.00001）, re-bleeding on postoperative （OR =0.24, 95% CI： O. 13 - 0.44, Z=4.59, P〈0.00001）, curerate （OR=0.19, 95% CI： 0.09-0.39, Z=4.49, P〈0.00001）. However, there was no statistically significant difference in adverse reactions （nausea, vomiting, constipation） between two groups （OR = 1.44, 95% CI： 0.56 -3.71, Z =0.75, P 〉0.05）. Conclusion The clinical efficacy of endoscopic electrocoagulation combined with Montmorillonite powder on gastric ulcer bleeding is better than single treatment with endoscopic electrocoagulation, it is worthy of clinical use.