清胰汤对重症急性胰腺炎治疗价值的系统评价

目的 用循证医学的方法评价清胰汤辅助治疗重症急性胰腺炎的疗效。方法 检索1966年到2007年7月间发表的有关清胰汤辅助治疗重症急性胰腺炎疗效的随机对照临床试验。按入选和排除标准，有9项临床试验纳入本研究，由2名评价者对入选研究中有关试验设计、研究对象的特征、研究结果等内容独立进行摘录，用RevMan4.2 软件进行分析。结果 清胰汤灌胃灌肠辅助治疗组的腹痛缓解时间（WMD=-24.72，95%CI: -35.06～-14.37，P＜0.01）、住院天数（WMD=-9.81，95%CI:-16.23～-3.39，P＜0.01）、病死率（OR=0.27，95%CI: 0.15～0.50，P＜0.01）均明显低于对照组，差异有统计学意义，并发症发生数两组尚无统计学差异（OR=0.31，95%CI:0.07～1.42，P=0.13）。结论 中药清胰汤辅助治疗能显著缩短重症急性胰腺炎患者的腹痛缓解时间、住院天数，明显降低病死率。

Efficacy of Qingyi decoction in the treatment of severe acute pancreatitis: systematic review and meta-analysis

Objective Qingyi decoction, a traditional Chinese herbal medicine, has been shown to have a good curative effect on acute pancreatitis in recent years. Many studies evaluating the efficacy of Qingyi decoction in the treatment of severe acute pancreatitis had been carried out, but their sample sizes were very small and results were not definite. The aim of this study is to evaluate the effectiveness of Qingyi decoction in the treatment of severe acute pancreatitis according to a systematic review and meta-analysis.Methods Medline, EMBASE, Cochrane library (from 1966 to July 2007) and China Biological Medicine Disk (from 1978 to July 2007) were searched for articles, using the MESH headings Qingyi, traditional Chinese drug, severe acute pancreatitis, randomized controlled trial. Bibliographies of journal articles were also searched for relevant studies. Only randomized trials that compared Qingyi decoction of adjunctive therapy with control group in severe acute pancreatitis were selected. Nine studies were enrolled into the analysis. The detail about the trial design, characters of the subjects, result s of the studies were reviewed by two independent authors and analysed by using Revman 4.2 software.Results Compared with control group, the use of adjunctive therapy with Qingyi decoction group was associated with significantly lower the time of stomachache relief (WMD=-24.72，95%CI: -35.06～-14.37，P＜0.01), hospital stay (days)（WMD=-9.81，95%CI:-16.23～-3.39，P＜0.01）and hospital death (OR=0.27，95%CI: 0.15～0.50，P＜0.01), and had the tendency of the lower incidence of complications (OR=0.31，95%CI:0.07～1.42，P=0.13). The “funnel plot” of the studies in the meta-analysis did not show any publication bias. Conclusion The systematic review and meta-analysis show that the adjunctive therapy with Qingyi decoction in severe acute pancreatitis can benefit for decreasing the time of stomachache relief, hospital stay and the incidence of hospital death. The routine adjunctive therapy with Qingyi decoction in severe acute pancreatitis should be recommended.