清胰汤经鼻空肠管和鼻胃管辅佐治疗急性胰腺炎疗效的系统评价

Qingyi decoction in the adjuvant treatment of acute pancreatitis via nasal jejunal tube and nasogastric tubes:A systematic review

目的系统评价清胰汤经鼻空肠管(NJ)和鼻胃管(NG)注入辅佐治疗急性胰腺炎(AP)的临床疗效与安全。方法计算机检索The Cochrane Library、Web of Science、PubMed、Embase、维普、万方医学网、SinoMed和中国知网数据库中有关清胰汤经NJ和NG 2种途径辅佐治疗AP的临床疗效的随机对照试验(RCT),检索时间从建库至2022年5月。文献的筛选、纳入研究中的相关资料提取及偏倚风险的评估由2名研究员独立完成,采用RevMan 5.4软件进行meta分析。结果共纳入5篇文献,共计433例经NJ和NG注入清胰汤治疗的AP患者。meta分析结果显示:清胰汤经NJ(试验组)注入辅佐治疗AP在腹痛缓解时间[均方差(MD)=-2.03,95%可信区间(95%CI)(-2.55,1.50),P<0.001]、肠鸣音恢复时间[MD=-1.16,95%CI(-1.58,-0.73),P<0.001]、血淀粉酶恢复正常时间[MD=-1.35,95%CI(-2.01,-0.68),P<0.001]、血白细胞值[MD=-2.65,95%CI(-4.13,-1.18),P=0.0004]、C反应蛋白恢复时间[MD=-1.85,95%CI(-2.62,-1.08),P<0.001]、住院时间[MD=-4.92,95%CI(-6.03,-3.81),P<0.001],并发症中肺部真菌感染[比值比(OR)=0.38,95%CI(0.19,0.79),P=0.01]、血液真菌感染[OR=0.32,95%CI(0.14,0.75),P=0.008]方面显著优于清胰汤经NG(对照组)注入辅佐治疗AP。结论清胰汤经NJ注入辅佐治疗AP可缩短腹痛缓解时间、肠鸣音恢复时间、住院时间,在降低AP患者炎症指标方面更具优势,可减少AP患者的痛苦,减轻患者家庭经济压力。

Objective To systematically evaluate the efficacy and safety of Qingyi decoction in the adjuvant treatment of acute pancreatitis(AP)via nasojejunal(NJ)and nasogastric(NG)tubes.Methods The Cochrane Library,Web of Science,PubMed,Embase,VIP,Wanfang Medical Network,SinoMed and CNKI databases were searched by computer for randomized controlled trail(RCT)on the clinical efficacy of Qingyi decoction in the adjuvant treatment of AP via NJ and NG tubes,from the establishment of the database to May 2022.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was performed using RevMan 5.4 software.Results A total of five studies were included,including 433 AP patients who were injected with Qingyi decoction via NJ and NG tubes.The results of meta-analysis showed that the time of abdominal pain relief[MD=-2.03,95%CI(-2.55,1.50),P<0.001],the recovery time of bowel sounds[MD=-1.16,95%CI(-1.58,-0.73),P<0.001],time of blood amylase to return to normal[MD=-1.35,95%CI(-2.01,-0.68),P<0.001],WBC value[MD=-2.65,95%CI(-4.13,-1.18),P=0.0004],time of CRP recovery[MD=-1.85,95%CI(-2.62,-1.08),P<0.001],time of hospitalization[MD=-4.92,95%CI(-6.03,-3.81),P<0.001],complications(pulmonary fungal infection)[OR=0.38,95%CI(0.19,0.79),P=0.01],complications(blood fungal infections)[OR=0.32,95%CI(0.14,0.75),P=0.008]in the adjuvant treatment of AP by Qingyi decoction via NJ tube(the experimental group)were significantly better than that via NG tube(the control group).Conclusion Qingyi decoction injected via NJ tube can shorten the relief time of abdominal pain,the recovery time of bowel sounds,and the length of hospitalization for AP patients.It has more advantages in reducing the inflammatory indicators of AP patients,and can reduce the pain of AP patients and relieve the economic pressure of their families.