内镜下金属钛夹对比药物治疗上消化道出血疗效的Meta分析

Comparison of therapeutic effect on endoscopic hemoclip and conservative drugs for the treatment of upper gastrointestinal bleeding: a meta-analysis

摘要:

评价内镜下金属钛夹治疗上消化道出血的临床价值。方法 通过计算机检索Pubmed、CNKI数据库、Web of Knowledge、Cochrane图书馆对照试验注册库、万方数据库从建库至2017年的有关内镜下金属钛夹对比药物注射治疗上消化道出血的相关文献，采用Cochrane协作网提供的RevMan 5.0版软件进行统计处理，对纳入资料的异质性进行分析，计算OR值和95%可信区间。结果 按照入选标准，纳入了7项临床试验，共704例患者。Meta分析结果显示，钛夹治疗上消化道出血有效率更高（OR=5.74，95%CI：3.28～10.04）、72 h再出血率低（OR=0.24，95%CI：0.14～0.43）、转外科手术率低（OR=0.14，95%CI：0.05～0.37）。结论 目前的研究结果显示，内镜下金属钛夹治疗上消化道出血的疗效优于单纯采用药物治疗，且该方法具有止血有效率高、72 h再出血率低和转外科手术率低等优点，具有临床推广及应用价值。

Abstract:

To evaluate the clinical value of endoscopic hemoclip in treatment of upper gastrointestinal bleeding. Methods The literature on endoscopic hemoclip and conservative drugs for the treatment of upper gastrointestinal bleeding was retrieved combined with manual retrieval from PUBMED, China National Knowledge Infrastructure (CNKI), Web of Knowledge, the Cochrane controlled trials register library repository, Wanfang Database published between inception and 2017 in China. RevMan 5.0 software from Cochrane cooperation network was used for data analysis. Pooled odds ratio (OR) and 95%confidence intervals (95%CI) were calculated and the heterogeneity was also assessed. Results According to the selection criteria, 7 clinical trials with seven hundred and four patients were selected finally. The combined results of meta-analysis showed that compared with conservative drugs, endoscopic hemoclip had higher effective rate [OR = 5.74, 95%CI (3.28, 10.04), P < 0.05], low rebleeding rate after 72 h [OR = 0.24, 95%CI (0.14, 0.43), P < 0.05], low surgical operation rate [OR = 0.14, 95%CI (0.05, 0.37), P < 0.05]. Conclusions Our study indicates that the curative effect of endoscopic hemoclip in the treatment of upper gastrointestinal bleeding is better than that of conservative drugs treatment. It has the advantages of higher effective rate, low rebleeding rate after 72 h, low surgical operation rate, and which is worthy of clinical promotion and application.