肾上腺素预防经内镜逆行胰胆管造影术后胰腺炎有效性的Meta分析

• 作 者: 宫宇澄 寇梦佳 王林恒 王志斌
• 机 构: 北京中医药大学，北京 100078;北京中医药大学东方医院脾胃肝胆科，北京 100078
• 出 处: 中华消化内镜杂志
• 发表日期: 2022年3期
• 关键词: Epinephrine Cholangiopancreatography endoscopic retrograde Pancreatitis Meta-ana

目的:系统评价肾上腺素预防经内镜逆行胰胆管造影术后胰腺炎（post-endoscopic retrograde cholangiopancreatography pancreatitis，PEP）的有效性。方法:计算机检索 PubMed、EMbase、The Cochrane Library、Web of Science、维普、中国知网及万方数据库及ClinicalTrials.gov、世界卫生组织国际临床试验注册平台，搜集关于肾上腺素预防PEP的随机对照试验，检索时限均从建库至 2020 年10月10日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 RevMan 5.3 软件进行Meta分析。结果:共检索获得410篇相关文献，最终纳入8项随机对照试验，包括 4 208 例患者。Meta 分析结果显示，与生理盐水组相比，使用肾上腺素能降低PEP的发生率（n RR=0.29，95%n CI：0.16~0.50，n P<0.001）。与吲哚美辛对照组相比，单用肾上腺素组（n RR=0.17，95%n CI：0.02~1.39，n P=0.100）和肾上腺素联合吲哚美辛组（n RR=1.15，95%n CI：0.61~2.16，n P=0.670）PEP发生率的差异均无统计学意义。n 结论:与生理盐水相比，在十二指肠乳头局部喷洒肾上腺素可降低PEP发生率。但肾上腺素及肾上腺素联合吲哚美辛预防PEP与吲哚美辛相比无明显优势。“,”Objective:To systematically evaluate the efficacy of epinephrine in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods:Randomized controlled trials (RCTs) on epinephrine for preventing PEP from inception to October 10, 2020 were searched in databases including PubMed, Embase, The Cochrane Library, Web of Science, VIP Information Network, China National Knowledge Infrastructure,WanFang Data,and clinical trial registration platforms including ClinicalTrials.gov,WHO International Clinical Trial Registration Platform. Literature was screened independently by two reviewers, data were extracted and the risk of bias of included studies were assessed. The meta-analysis was performed by RevMan 5.3.Results:A total of 410 papers were retrieved and 8 RCTs involving 4 208 patients were included. The results of meta-analysis showed that compared with the saline group, the epinephrine could reduce the incidence of PEP (n RR=0.29,95%n CI:0.16-0.50,n P<0.001). There were no significant differences in the therapeutic effect between group epinephrine and group indomethacin (n RR=0.17,95%n CI:0.02-1.39,n P=0.100) or group indomethacin combined with epinephrine and group indomethacin (n RR=1.15,95%n CI:0.61-2.16,n P=0.670).n Conclusion:Local spraying of epinephrine on the duodenal papilla can reduce the incidence of PEP compared with normal saline. But the epinephrine or combination of indomethacin and epinephrine fails to reveal any benefit over indomethacin alone in preventing PEP.