垂体后叶素联合奥曲肽治疗肝硬化上消化道出血临床效果的Meta分析

蔡艳萍++薛顺和

[摘要] 目的 系統性评价垂体后叶素联合奥曲肽对肝硬化上消化道出血的疗效。 方法 系统检索PubMed、The Cochrane Library、Web of Science和万方、中国知网、中国生物医学文献数据库、维普数据库中关于垂体后叶素联合奥曲肽治疗上消化道出血临床效果的文献，检索词包括“垂体后叶素、奥曲肽、上消化道出血”，检索时限均从建库截至2016年7月。由2名研究者按照纳入与排除标准独立筛选文献、提取资料并评价质量后，采用RevMan 5.2软件进行Meta分析。 结果 最终纳入7项随机对照实验，共658例患者，其中实验组337例，对照组321例。Meta分析结果显示：实验组总有效率明显高于对照组，而止血时间明显短于对照组，且差异均有统计学意义（MD = 7.33，95%CI：3.83～14.03，P < 0.01；MD = -8.57，95%CI：-13.62～-3.52，P < 0.01）。两组不良反应发生率比较，差异无统计学意义（P > 0.05）。 结论 与单独使用奥曲肽相比，垂体后叶素联合奥曲肽治疗上消化道出血能明显提高总有效率，缩短止血时间。

[关键词] 垂体后叶素；奥曲肽；上消化道出血；Meta分析

[中图分类号] R573.2 [文献标识码] A [文章编号] 1673-7210（2017）06（b）-0119-04

1.College of Nursing， Weinan Vocational and Technical College， Shaanxi Province， Weinan 714000， China； 2.Department of Gastroenterology， Affiliated Hospital of Yan'an University， Shaanxi Province， Yan'an 716000， China

[Abstract] Objective To systemically review the efficacy of hypophysin combined with Octreotide in the treatment of liver cirrhosis with upper gastrointestinal hemorrhage. Methods The literatures about the efficacy of hypophysin combined with Octreotide in the treatment of upper gastrointestinal hemorrhage were searched systemically in the database of PubMed， The Cochrane Library， Web of Science and WanFang， CNKI， CBM and VIP， the search words included "hypophysin， Octreotide， upper gastrointestinal hemorrhage"， the retrieval time limit was from the establishment of database to July 2016， 2 reviewers independently screened literatures according to the inclusion and exclusion criteria， extracted data， and assessed the risk of bias of included studies. Then Meta-analysis was performed using RevMan5.2 software. Results A total of 7 RCTs involving 658 patients were included， including 337 cases in the experimental group and 321 cases in the control group. The results of Meta-analysis showed that the total effective rate of experimental group was higher than that of the control group， the hemostatic time was shorter than that of control group， the differences were all statistically significant （MD = 7.33， 95%CI： 3.83-14.03， P < 0.01； MD = -8.57， 95%CI： -13.62 - -3.52， P < 0.01）. There was no significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion Compared to the single use of Octreotide， hypophysin combined with Octreotide can effectively improve the total effective rate and shorten the hemostatic time.

[Key words] Hypophysin； Octreotide； Upper gastrointestinal hemorrhage； Meta-analysis

静脉曲张出血是肝硬化门脉高压的严重并发症，其发病致死的概率为20%～40%，且50%～80%首次出血存活者最终可再次发生出血[1]。内镜止血取得了一定的进展，但使用内镜止血的前提是药物基本控制出血、血液动力学基本稳定后，才能获得清晰视野。因此，药物治疗与内镜治疗是相辅相成的。况且，对于广大基层医院，由于技术和设备的原因，首选治疗仍是药物[2]。目前，药物主要包括抑酸剂、凝血酶及血管加压素等，血管加压素多采用垂体后叶素，但它对心血管的不良反应较大，在使用中受剂量限制，疗效欠佳，奥曲肽是一种人工合成的天然生长抑素的八肽衍生物，具有天然生长抑素的类似作用，并且作用持续时间长，但药物价格昂贵，应用时间较长，也限制其应用[3]。……