内镜套扎与普萘洛尔治疗肝硬化食管胃底静脉曲张出血一级预防Meta分析

发布时间：2018-05-02 07:43

本文选题：普萘洛尔 + 食管胃底静脉曲张出血　；参考：《大连医科大学》2014年硕士论文

【摘要】：背景:食管胃底静脉曲张破裂出血(esophageal and gastric varicesbleeding，EGVB)病情危急，死亡率高达43.5%，故积极防治静脉曲张首次出血显得尤为关键。内镜套扎术（endoscopic variceal ligation，EVL）和普萘洛尔（propranolol，PPL）是EGVB首次出血预防一线诊疗措施。临床中何者具有更高的临床疗效，至今仍众说纷纭。目的：比较PPL和EVL防治EGVB首次出血疗效及安全性，为临床实践提供循证医学指导。方法:在PubMed、万方数据资源系统、MEDLINE、百链外文搜索、维普资讯网（VIP）及中国知网(CNKI)系统全面进行中文及外文语种文献搜索。纳入所有符合本Meta的随机对照试验（randomized controlled trials，，RCTs）；同时将检索所有文献的参考文献作为参考补充。检索具体日期从1999年1月到2013年12月。通过浏览检索文献标题、摘要及全文，排除不符合纳入标准的随机对照试验。本文选择死亡率、出血率、出血相关死亡率、药物不良反发生率应及门脉高压性胃粘膜病变发生率作为最终的分析指标。对纳入文献研究的随机对照实验提取数据后进一步质量评价和研究后，运用RevMan5.2软件统计分析。结果：本文总计10项RCT纳入研究，包括1000名患者，其中PPL组495例，，EVL组有505例。本文合并研究结果显示：研究发现二种治疗方式在消化道出血相关死亡率[RR=0.84、95%CI（0.49,1.45）、P=0.53]、死亡率[RR=1.10、95%CI（0.86,1.40）、P=0.45]、首次出血率[RR=0.77、95%CI（0.48,1.25）、P=0.29]、P=0.53]、门脉高压性胃粘膜病变发生率[RR=1.17、95%CI（0.66,2.07）、P=0.59]等方面，二组的差别无统计学意义。但EVL组不良反应发生率（21.2%）较PPL组不良反应发生率（7.2%）高，两组间差异有统计学意义[RR=2.81、95%CI（1.75,4.52）、P＜0.0001]。结论：PPL治疗同EVL治疗相比，虽然在死亡率、首次出血率、出血相关死亡率、门脉高压性胃粘膜病变发生率等方面没有优势，但PPL组不良反应发生率较低。
[Abstract]:Background: esophageal and gastric varicesbleeding (EGVB) is critical and the death rate is up to 43.5%. Therefore, it is critical to actively prevent and cure variceal bleeding for the first time. Endoscopic ligation (endoscopic variceal ligation, EVL) and general Lol (propranolol, PPL) are the first-line diagnosis and treatment of the first hemorrhage of EGVB. Measures, which have higher clinical efficacy in clinical practice, are still widely divergent.
Objective: To compare the efficacy and safety of PPL and EVL in the prevention and treatment of EGVB for the first time, so as to provide evidence-based medical guidance for clinical practice.
Methods: PubMed, Wanfang Data Resource System, MEDLINE, 100 chain foreign search, VP information network (VIP) and Chinese knowledge network (CNKI) system for comprehensive Chinese and foreign language literature search. All the randomized controlled trials (randomized controlled trials, RCTs) which conform to this Meta are included; and the reference literature of all documents will be retrieved as a reference. The specific date from January 1999 to December 2013 was retrieved from January 1999 to December 2013. By browsing the titles, abstracts and full text of the literature, a randomized controlled trial was excluded from the inclusion criteria. The mortality rate, bleeding rate, bleeding related mortality, the incidence of adverse drug reaction and the incidence of portal hypertensive gastric mucosal lesions were selected as final analysis. Indicators. After further evaluation and Research on the quality of data extracted from randomized controlled trials involving literature, RevMan5.2 software was used for statistical analysis.
Results: a total of 10 RCT included 1000 patients, including 495 cases in group PPL, and 505 in group EVL. The results of this study showed that the death rate of two treatments in the digestive tract bleeding associated mortality [RR=0.84,95%CI (0.49,1.45), P=0.53], mortality [RR=1.10,95%CI (0.86,1.40), P=0.45], and initial bleeding rate [RR=0.77,95%C) The incidence of I (0.48,1.25), P=0.29], P=0.53], the incidence of gastric mucosal lesions in the portal hypertension, [RR=1.17,95%CI (0.66,2.07), P=0.59], etc., was not statistically significant in the two groups, but the incidence of adverse reactions in the EVL group (21.2%) was higher than that in the PPL group (7.2%), and the difference between the two groups was statistically significant [RR=2.81,95%CI (1.75,4.52).
Conclusion: compared with EVL treatment, PPL treatment has no advantages in mortality, first bleeding rate, bleeding related mortality, and the incidence of portal hypertensive gastric mucosal lesions, but the incidence of adverse reactions in the PPL group is low.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

【参考文献】