非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的系统评价

摘要

目的 评价非甾体类抗炎药(NSAIDs)直肠给药预防ERCP术后胰腺炎的有效性和安全性.方法 制定严格纳入和排除标准,计算机检索Cochrane图书馆临床对照试验、Medline、PubMed、Embase、OVID数据库、中国生物医学文献数据库(CBMDisc)、维普中文期刊数据库、中国期刊全文数据库、万方学位论文数据库).并手工检索相关会议论文集及查阅检索到的所有参考文献,全面收集国内外关于非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的随机对照试验.按照国际Cochrane协作网推荐的方法进行系统评价.结果 共纳入10个试验2802例患者,Meta分析显示:①PEP发生率、轻症PEP发生率及中-重症PEP发生率:NSAIDs治疗组优于安慰剂组(均P＜0.001).②术后高胰淀粉酶血症发生率及术后血胰淀粉酶水平:NSAIDs治疗组优于安慰剂组(均P＜0.001).③PEP病死率及不良反应发生率:无病死率及NSAIDs治疗相关不良反应的报道.结论 NSAIDs直肠给药可以预防ERCP术后胰腺炎的发生,且安全性好.%Objective To determine the effectiveness and safety of rectal NSAIDs in the prevention of post-ERCP pancreatitis.Methods We searched Cochrane Central Register ot Controlled Trails (CENTRAL),MEDLINE or PUBMED,EMBASE,OVID Database,Chinese Biological Medicine database(CBMDisc),CNKI,Chinese VIP Database and WANFANG database,and hand searched the bibliographies of retrieved articles and correlated proceedings.systematic review was conducted using the method recommended by The Cochrane Collaboration.Results Ten trials involving 2802 patients were included in the systematic review.Meta analysis showed.The prevalence of post-ERCP pancreatitis,mild PEP and moderate to severe PEP:rectal NSAIDs therapy were superior to placebo(P＜0.00001,P＜0.00001,P=0.0006) ; The incidence of hyperamylasemia and the serum amylase levels:rectal NSAIDs therapy were superior to placebo(P＜0.0001,P=0.0008).Case fatality and adverse effect rate:no patient in these trials had Complications.Conclusions The current evidence showed that:Rectal NSAIDs in the prevention of post-ERCP pancreatitis is safe and effective.