大承气汤联合奥曲肽及常规疗法治疗术后早期炎性肠梗阻疗效及安全性的Meta分析

Meta-analysis of efficacy and safety of Dachengqi Decoction combined with octreotide and conventional therapy for early postoperative inflammatory small bowel obstruction

目的系统评价大承气汤联合奥曲肽及常规疗法治疗术后早期炎性肠梗阻(EPISBO)的有效性和安全性。方法计算机检索PubMed、中国知网(CNKI)、万方数据知识服务平台(WanFang Data)、维普中文期刊服务平台(VIP)等数据库,收集以奥曲肽联合常规疗法为对照,观察大承气汤联合奥曲肽及常规疗法治疗EPISBO有效性及安全性的临床随机对照试验文献,文献发表时间为建库至2022年8月5日。采用Cochrane系统评价手册评价纳入文献的方法学质量,提取相关数据,借助RevMan5.4软件对数据进行Meta分析。结果共纳入6篇文献,涉及病例624例。Meta分析结果显示,大承气汤联合奥曲肽及常规疗法治疗EPISBO的总有效率高于奥曲肽联合常规疗法[OR=7.16,95%CI(3.32,15.44)],且能更好地缓解腹痛腹胀[MD=-1.81,95%CI(-2.71,-0.92)],促进肛门排气[MD=-0.95,95%CI(-1.21,-0.69)]及排便[MD=-0.62,95%CI(-0.95,-0.29)],缩短症状消失时间[MD=-1.55,95%CI(-2.70,-0.40)],差异有统计学意义(P<0.01)。与奥曲肽联合常规疗法相比,在降低肿瘤坏死因子-α(TNF-α)[MD=-3.87,95%CI(-8.32,0.58)]、超敏C反应蛋白(hs-CRP)[MD=-4.11,95%CI(-8.90,0.69)]、白介素-6(IL-6)[MD=-41.86,95%CI(-107.38,23.65)]水平以及不良反应发生率[MD=0.91,95%CI(0.40,2.07)]方面,大承气汤联合奥曲肽及常规疗法未见明显优势(P>0.05)。结论大承气汤联合奥曲肽及常规疗法治疗EPISBO疗效较好,但由于纳入的文献数量较少、质量较低,所得结论仍需更高质量的研究加以论证。

Objective To systematically evaluate the efficacy and safety of Dachengqi Decoction(DCQD)combined with octreotide and conventional therapy in the treatment of early postoperative inflammatory small bowel obstruction(EPISBO).Methods Clinical randomized controlled trials(RCTs)that observed the effectiveness and safety of DCQD plus octreotide and conventional therapy in treating EPISBO with octreotide plus conventional therapy as the control were retrieved by searching the following databases as China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform(WanFang Data)and VIP Chinese Journal Service Platform(VIP),etc.The collected RCTs were published between the dates of database establishment and August 5,2022.The Cochrane systematic review manual was used to evaluate the methodological quality of the included RCTs and extract relevant data,and RevMan 5.4 was used to perform a meta-analysis of the extracted data.Results The included 6 articles involved 624 cases.The meta-analysis showed that the total effective rate of DCQD plus octreotide and conventional therapy for EPISBO was higher than that of octreotide plus conventional therapy[OR=7.16,95%CI=(3.32,15.44)],and DCQD plus octreotide and conventional therapy could better relieve abdominal pain and bloating[MD=-1.81,95%CI=(-2.71,-0.92)],facilitate anal gas evacuation[MD=-0.95,95%CI=(-1.21,-0.69)]and defecation[MD=-0.62,95%CI=(-0.95,-0.29)],and shorten the time course of symptom disappearance[MD=-1.55,95%CI=(-2.70,-0.40)],with a statistically significant difference(P<0.01).DCQD plus octreotide and conventional therapy had no significant advantage in lowering levels of tumor necrosis factor-α(TNF-α)[MD=-3.87,95%CI=(-8.32,0.58)],hypersensitive C-reactive protein(hs-CRP)[MD=-4.11,95%CI=(-8.90,0.69)],interleukin-6(IL-6)[MD=-41.86,95%CI=(-107.38,23.65)],and the incidence of adverse reactions[MD=0.91,95%CI=(0.40,2.07)](P>0.05).Conclusion DCQD plus octreotide and conventional therapy has quite good efficacy in the treatment of EPISBO,but the conclusion needs to be validated by studies of higher quality due to the low quantity and quality of included literature.