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[目的]系统评价非甾体类抗炎药双氯芬酸钠直肠给药预防经内镜逆行胰胆管造影术后胰腺炎(PEP)的有效性及安全性。[方法]计算机检索中国知网、万方数据库、重庆维普、中国生物医学文献数据库、西文生物医学期刊文献服务系统及Pubmed数据库,收集从建库至2016年11月所有双氯芬酸预防PEP的随机对照试验(RCT),并根据文献纳入标准筛选文献,采用Jadad量表对纳入的文献进行质量评价,应用Cochrane协作网提供的Revman5.3软件进行Meta分析。[结果]共纳入9个RCT,共计1730例PEP患者。Meta分析结果显示:应用双氯芬酸钠可降低PEP发病率,且直肠途径给药综合效果更好,9个纳入研究均未报告药物相关不良反应。[结论]双氯芬酸钠可有效降低PEP的发病率,且经直肠给药相对安全。鉴于本系统评价纳入研究的方法学局限性,且例数有限,上述结论尚待开展更多大样本、高质量的RCT加以验证。
[Objective] To evaluate the effectiveness and safety of rectal administration of diclofenac sodium, a non-steroidal anti-inflammatory drug, to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (PEP). [Methods] We searched all the databases of CNKI, Wanfang Database, Chongqing Weipu, Chinese Biomedical Literature Database, Western Biomedical Journals Literature Service System and Pubmed Database to collect all the randomized controlled trials of diclofenac against PEP from the database to November 2016 (RCT), and according to the literature included in the standard screening literature, using the Jadad scale quality evaluation of the included literature, the use of Cochrane Collaboration Revman5.3 software Meta analysis. [Results] A total of 9 RCTs were enrolled, a total of 1730 PEP patients. Meta-analysis showed that the application of diclofenac sodium can reduce the incidence of PEP, and the combination of the rectum better overall effect, nine included in the study did not report drug-related adverse reactions. [Conclusion] Diclofenac sodium can effectively reduce the incidence of PEP, and rectal administration is relatively safe. In view of the methodological limitations of the systematic review included in the study and the limited number of cases, the above conclusion has yet to be carried out with a larger sample of high quality RCTs.