中药灌肠促进腹部手术后胃肠功能恢复的meta分析

Meta-analysis on the improvement of gastrointestinal function after abdominal operation by Chinese herbal enema

目的对中药灌肠促进术后胃肠功能恢复的随机对照试验的临床研究文献进行meta分析,分析疗效,为中药灌肠在术后胃肠功能的恢复中的临床应用提供临床参考。方法运用计算机检索PubMed、中国生物医学文献数据库(CBM)、中国知网(CNKI)上的关于中药灌肠促进腹部非胃肠道手术后胃肠功能恢复的随机对照试验,检索文献截止时间限定至2019年12月31日。由2名研究者独立筛选文献、提取资料和评价纳入研究偏倚后,用RevMan 5.3软件对最终符合要求的文献进行meta分析。结果纳入研究文献13篇,患者1464例,其中试验组794例、对照组670例。meta分析结果:以术后首次排气时间为结局指标,试验组和对照组相比差异有统计学意义[WMD=-14.40(-18.95,-9.84),Z=6.19,P<0.00001];以术后首次排便时间为结局指标,试验组和对照组相比差异有统计学意义[WMD=-12.12(-13.00,-11.24),Z=27.06,P<0.00001];以术后肠鸣音恢复时间为结局指标,试验组和对照组相比差异有统计学意义[WMD=-8.01(-8.52,-7.49),Z=30.29,P<0.00001];以术后恢复正常进食时间为结局指标,试验组和对照组相比差异有统计学意义[WMD=-16.14(-30.38,-1.90),Z=2.22,P=0.03];以术后腹胀缓解时间为结局指标,试验组和对照组相比差异有统计学意义[WMD=-10.58(-12.18,-8.97),Z=12.92,P<0.00001];以术后腹胀、恶心、呕吐发生例数为结局指标,试验组和对照组相比差异有统计学意义[OR=0.14(0.06,0.35),Z=4.20,P<0.0001]。结论中药灌肠联合术后常规治疗能够改善腹部手术后胃肠功能恢复,是可供临床选择的治疗方案。由于纳入文献的质量较低,尚存在一定的发表性偏倚,有待于今后开展高质量临床研究提供循证医学证据。

Objective To conduct a meta-analysis on clinical study literatures about randomized controlled trials of Chinese herbal enema promoting postoperative gastrointestinal function recovery and evaluate its efficacy in order to provide basis and clinical reference for the recovery of gastrointestinal function after Chinese herbal enema.Methods PubMed,China Biology Medicine disc(CBM),and China National Knowledge Infrastructure(CNKI)were searched through computer to collect published randomized controlled trials of Chinese herbal enema promoting gastrointestinal function recovery after abdominal non-gastrointestinal surgery.The deadline for literature publishing was December 31,2019.Two reviewers independently screened the literatures,extracted the data,and evaluated the bias of included studies.A meta-analysis was conducted for the literatures finally meeting the requirements by RevMan 5.3 software.Results Totally 13 literatures involving 1464 cases were selected,including 794 cases in the experimental group and 670 cases in the control group.According to the results of the meta-analysis,taking the first postoperative exhaust time as the outcome index,there was a statistically significant difference between the experimental group and the control group[WMD=-14.40(-18.95,-9.84),Z=6.19,P<0.00001];taking the first postoperative defecation time as the outcome index,there was a statistically significant difference between the experimental group and the control group[WMD=-12.12(-13.00,-11.24),Z=27.06,P<0.00001];taking the postoperative recovery time of bowel sounds as the outcome index,there was a statistically significant difference between the experimental group and the control group[WMD=-8.01(-8.52,-7.49),Z=30.29,P<0.00001];taking the postoperative normal feeding time as the outcome index,there was a statistically significant difference between the experimental group and the control group[WMD=-16.14(-30.38,-1.90),Z=2.22,P=0.03];taking the postoperative abdominal distension relief time as the outcome index,there was a statistically significant difference between the experimental group and the control group[WMD=-10.58(-12.18,-8.97),Z=12.92,P<0.00001];taking the number of cases of postoperative abdominal distension,nausea and vomiting as the outcome index,there was a statistically significant difference between the experimental group and the control group[OR=0.14(0.06,0.35),Z=4.20,P<0.0001].Conclusions Chinese herbal enema combined with routine postoperative treatment can improve the clinical efficacy of gastrointestinal function recovery after abdominal surgery and can be used as a clinical therapeutic option.However,due to the low quality of the included literatures,there is still certain publication bias.The above results shall be further proved on the basis of the evidence-based medicine in high-quality clinical studies in the future.