不同时段给药对吲哚美辛栓剂预防ERCP术后胰腺炎的作用分析

【中文】 目的：对吲哚美辛栓剂预防ERCP术后胰腺炎的作用,及不同给药时时段对药物作用的影响进行系统性评估。 方法：对2000-2012间发表的文献进行检索,纳入关于吲哚美辛栓剂预防PEP的随机对照研究(RCT),jadad评分评估文献质量, Revman5.0软件行数据统计分析。 结果：按检索策略入选8个临床研究,数据分析结果：1.吲哚美辛组的PEP发生相对风险率为对照组的43%,(RR=0.43, 95%CI:0.32,0.58,P>0.05)；2.按不同时段给药时间的亚组分析中,T₁组(术前2hr-30min)和T₃组(术后)中PEP发生相对风险率分别为对照组的34%(RR=0.34,95%CI:0.20,0.58)和51%(RR=0.51,95%CI:0.34,0.75)。T₂组(术前30min-0min)中与对照组的PEP发生率无明显差异； 3. 吲哚美辛栓组中、重症pep发生率亦明显降低(RR=0.38, 95%CI:0.21,0.68)。结论：吲哚美辛栓剂能有效预防PEP；术前2hr-30min和术后给药能明显降低PEP的发生率,术前30min内给药的结果尚不肯定,吲哚美辛栓剂可以有效预防术后高淀粉酶血症,和减少中重症pep发生率。

Rectal Indomethacin for Prevention of Post-ERCP Pancreatitis

: Objective:To evaluate the effect of rectal indomethacin for prevention of post-ERCP pancreatitis by Meta analysis.Method: Search the resource for RCTs those on the effect of indomethacin for prevention of post-ERCP pancreatitis, qualify the trials by jadad score ,and analyse data by Renman 5.0. Results:8 trials enrolled . Meta analysis results in :1) the incidence of PEP in rectal indomethacin group versus placebo group show a relative risk of 43%,(RR=0.43, 95%CI:0.32,0.58,P>0.05)2. As for subgroups of different medication time, the incidence of PEP in subgroup T1(2hr-30min prior to ERCP) and subgroup T3(post-ERCP) relatively showed a significant34%(RR=0.34,95%CI:0.20,0.58)and 51%(RR=0.51,95%CI:0.34,0.75).There is no obvious difference in subgroup T2(within 30min prior to ERCP).3.The incidences of hyperamylasemia and mild-severe pancreatitis were both lower in indomethacin group than in control group. Conclusion: Rectal indomethacin is effective for prevention of post-ERCP pancreatitis. Administration of indomethacin at 2hr-30min prior to ERCP or post-ERCP shows a significant lower incidence of PEP,but still unsure when taken within 30min prior to ERCP.Indomethacin also decreases the risk of hyperamylasemia and mild-severe pancreatitis