复方大承气汤治疗粘连性肠梗阻的 Meta分析和试验序贯分析

Meta Analysis and Trial Sequential Analysis of Compound Dachengqi Decoction in the Treatment of Adhesive Intestinal Obstruction

目的系统评价复方大承气汤治疗粘连性肠梗阻的临床疗效。方法检索中国知网、维普、万方、PubMed、Embase、the Cochrane Library数据库,时间为建库至2021年3月,查找复方大承气汤治疗粘连性肠梗阻的临床试验。采用Revman 5.3进行Meta分析,TSA 0.9进行试验序贯分析,Stata 15.0进行发表偏倚评估,GRADE 3.6进行评价证据质量。结果共纳入9项研究,共计患者899例。Meta分析显示,相对于常规方案,复方大承气汤联合常规方案能有效提高治疗粘连性肠梗阻的临床总有效率[RR=1.24,95%CI=(1.17,1.32),P<0.00001],降低肛门排气时间[MD=-2.46,95%CI=(-2.94,-1.98),P<0.00001]和胃管拔除时间[MD=-3.01,95%CI=(-3.59,-2.43),P<0.00001],试验序贯分析显示临床总有效率结局具有确切证据。Harbord检验显示不存在显著发表偏倚(P=0.88)证据质量评价显示临床总有效率的证据质量为低,肛门排气时间和胃管拔除时间的证据质量均为极低,推荐强度为弱推荐。结论复方大承气汤联合常规方案治疗粘连性肠梗阻的有效性优于常规方案,具有进一步研究的价值。

Objective To systematically evaluate the clinical efficacy of compound Dachengqi decoction in the treatment of adhesive intestinal obstruction(AIO).Methods The CNKI,VIP,Wanfang,PubMed,Embase,and the Cochrane Library databases were searched to find out literatures about clinical trial of compound Dachengqi decoction in the treatment of adhesive intestinal obstruction from the establishment of database to March 2021.Meta analysis was carried out with Revman 5.3,trial sequential analysis was carried out with TSA 0.9,publication bias assessment was carried out with Stata 15.0,and evidence quality was evaluated with GRADE 3.6.Results A total of 9 studies were included,involving 899 patients.Meta analysis showed that compared with the conventional regimen,compound Dachengqi decoction combined with the conventional regimen can effectively improve the total effective rate in the treatment of clinical symptoms of adhesive intestinal obstruction[RR=1.24,95%CI=(1.17,1.32),P<0.00001],and reduce the time of anal exhaust[MD=-2.46,95%CI=(-2.94,-1.98),P<0.00001]and gastric tube extraction[MD=-3.01,95%CI=(-3.59,-2.43),P<0.00001].The trial sequential analysis showed that clear evidences were for the total clinical effective outcome.Harbord test showed no significant publication bias(P=0.88).The quality of evidence assessment showed that the quality of evidence for total clinical response was low,the quality of evidence for time to anal exhaust and gastric tube removal was very low,and the strength of the recommendation was weak.Conclusion Compound Dachengqi decoction combined with conventional treatment is more effective than conventional treatment for adhesive intestinal obstruction,and has the value of further research.