中药灌肠治疗弥漫性腹膜炎术后胃肠道功能异常的Meta分析

Traditional Chinese Medicine Enema Treatment of Diffuse Peritonitis Postoperative Gastrointestinal Dysfunction:a Meta-analysis

目的:对国内外已发表的有关中药灌肠治疗弥漫性腹膜炎术后胃肠道功能异常的临床疗效及优势进行Meta分析。方法:计算机检索中国医学文献数据库(SinoMed)、维普数据库(VIP)、中国期刊全文数据库(CNKI)、万方数据库(WanFang Data)、中国科学引文索引数据库(CSCI)、Pubmed、Cochrane Library、PHM数据库,检索时限为建库至2019年10月,2名评价者独立筛选文献、提取资料和评价纳入研究偏倚后,采用RevMan5.3软件进行Meta分析。结果:最终纳入10项随机对照试验(RCT),总病例数813例,实验组420例,对照组393例。Meta分析结果显示:与对照组比较,中药灌肠联合术后常规西医治疗弥漫性腹膜炎术后患者能缩短肛门排气恢复时间[MD=-24.54,95%CI(-33.14,-15.94),P<0.00001]、肠鸣音恢复时间[MD=-12.41,95%CI(-16.39,-8.43),P<0.00001]、肛门排便恢复时间[MD=-28.36,95%CI(-40.89,-15.83),P<0.00001],减少继发肠梗阻发生[RR=0.18,95%CI(0.08,0.42),P<0.0001]、多器官功能障碍综合征(MODS)发生率[RR=0.29,95%CI(0.09,0.92),P=0.03]。在肺部感染方面,观察组和对照组未见明显差异[RR=0.38,95%CI(0.14,1.01),P=0.05],在伤口感染方面,观察组和对照组未见明显差异[RR=0.45,95%CI(0.19,1.06),P=0.07]。结论:在术后常规西医治疗的基础上联合中药灌肠,缩短肠鸣音恢复时间、肛门排气恢复时间、肛门排便恢复时间,减少继发性肠梗阻及MODS发生率。但纳入文献质量偏低,需高质量RCT进一步验证。

Objective To conduct a Meta-analysis on the clinical efficacy and advantages of Traditional Chinese Medicine enema in the treatment of gastrointestinal dysfunction after diffuse peritonitis.Methods SinoMed,VIP,CNKI,WanFang Data,CSCI,Pubmed,Cochrane Library and PHM database were searched by computer.The retrieval time was from the establishment of the database to October 2019.Two reviewers independently screened the literature,extracted data and evaluated the inclusion of study bias.Then RevMan5.3 software was usedfor Meta-analysis.Results 10 Randomized Controlled Trials(RCT)were included,with a total of 813 cases,420 in the experimental group and 393 in the control group.The results of Meta-analysis showed that compared with the control group,traditional Chinese medicine enema combined with conventional western medicine treatment after diffuse peritonitis can shorten the recovery time of anal exhaust[MD=-24.54,95%CI(-33.14,-15.94),P<0.00001],bowel sound recovery time[MD=-12.41,95%CI(-16.39,-8.43),P<0.00001]and the recovery time of anal defecation[MD=-28.36,95%CI(-40.89,-15.83),P<0.00001],reduced the incidence of secondary intestinal obstruction[RR=0.18,95%CI(0.08,0.42),P<0.0001]and multiple organ dysfunction syndrome(MODS)[RR=0.29,95%CI(0.09,0.92),P=0.03].There was no significant difference in pulmonary infection between the observation group and the control group[RR=0.38,95%CI(0.14,1.01),P=0.05]and no significant difference in wound infection between the observation group and the control group[RR=0.45,95%CI(0.19,1.06),P=0.07].Conclusion On the basis of conventional western medicine treatment,combined with traditional Chinese medicine enema can shorten the recovery time of bowel sounds,anal exhaust and anal defecation,and reduce the incidence of MODS and secondary intestinal obstruction.However,the quality of the included literature is low,which requires further verification by high-quality RCT.