围手术期利用乳酸林格氏液积极补液预防经内镜逆行胰胆管造影术术后胰腺炎的Meta分析

Prophylactic value of aggressive hydration with lactated Ringer's solution during the perioperative period for post-ERCP pancreatitis: a meta-analysis

目的评价围手术期使用乳酸林格氏液(lactatedRinger′ssolution,LRS)积极补液对降低经内镜逆行胰胆管造影(ERCP)术后胰腺炎(post-ERCPpancreatitis,PEP)发病率的价值。方法检索中国期刊全文数据库(CNKI)、维普、万方数据库、PubMed、Embase、Cochrane图书馆,收集LRS积极补液治疗预防ERCP术后胰腺炎的随机对照试验(RCT),检索时限为建库至2018年6月。由2名研究者按纳入及排除标准独立选择试验、提取资料和评估方法学质量,采用Revman5.3软件进行Meta分析,各纳入研究间的异质性分析采用Q检验及I2检验,采用漏斗图、偏倚风险图、偏倚风险总结图进行偏倚评价。结果纳入10篇随机对照试验,共1727例患者,Meta分析结果显示:10篇文献之间无明显异质性(P=0.10,I^2=39%),利用LRS积极补液可以降低PEP的发病率(OR=0.37,95%CI:0.26~0.53,P<0.00001)。有6篇文献记录了高淀粉酶血症(hyperamylasemia,HA)的发生率,结果显示利用LRS积极补液可降低HA的发生率(OR=0.41,95%CI:0.27~0.64,P<0.00001)。有4篇文献对比了试验组与对照组间ERCP术后上腹痛的发生率,结果显示利用LRS积极补液可降低上腹痛的发生率(OR=0.32,95%CI:0.15~0.68,P=0.003)。结论利用乳酸林格氏液积极补液能有效预防经内镜逆行胰胆管造影术后胰腺炎等并发症的发生。

Objective To evaluate aggressive hydration with lactated Ringer′s solution for prophylaxis of post-ERCP pancreatitis(PEP) during the perioperative period. MethodsCNKI, VIP, Wangfang, Pubmed, Embase and Cochrane Library were searched for randomized controlled trials(RCTs)on aggressive hydration with lactated Ringer′s solution for preventing PEP published from the setup time of databases to June 2018. According to the inclusion and exclusion criteria, RCTs were selected by two researchers, data were extracted and methodological quality was assessed independently. Revman 5.3 was used to perform the meta-analysis.The heterogeneity among the included RCTs was analyzed by using the Q test and the chi-square test. The funnel plots, the risk of bias graph and the risk of bias summary were used to evaluate publication bias. ResultsA total of 10 RCTs with 1 727 patients were included.Meta-analysis showed that 10 RCTs had no significant heterogeneity (P=0.10, I^2=39%), aggressive hydration with lactated Ringer′s solution could reduce the incidence of PEP(OR=0.37, 95%CI: 0.26-0.53, P<0.000 01). Hyperamylasemia incidence was included in 6 RCTs, and the results showed that aggressive hydration with lactated Ringer′s solution could reduce the incidence of hyperamylasemia (OR=0.41, 95%CI: 0.27-0.64, P<0.000 01). A total of 4 RCTs compared the incidence of abdominal pain after ERCP between the experimental group and the control group. Meta-analysis showed that aggressive hydration with lactated Ringer′s solution could reduce the incidence of abdominal pain (OR=0.32, 95%CI: 0.15-0.68, P=0.003). ConclusionAggressive hydration with lactated Ringer′s solution can effectively prevent PEP and other complications.