上消化道出血患者内镜检查前给予红霉素疗效的Meta分析

Administration of erythromycin before endoscopy in upper gastrointestinal bleeding: a Meta-analysis

摘要:

目的 上消化道出血（UGIB）患者内镜检查前注射红霉素可以帮助清除胃内血凝块，改善内镜检查视野，但其有效性及相关临床益处仍存在争议，为了进一步评估并客观评价，该研究对急性UGIB患者内镜检查前输注红霉素的疗效进行Meta分析。方法 对PubMed、Embase、The Cochrane Library和中国知网进行检索，检索时间为建库至2022年1月，以获得比较UGIB患者内镜前使用红霉素与不使用红霉素或安慰剂的随机对照试验（RCT）。使用比值比（OR＾）或均数差（MD）计算胃内良好视野率、是否需要第二次内镜检查、手术时间、住院时间和输血情况，并评估异质性和发表偏倚。结果 共纳入12篇RCT，有914例患者（红霉素组448例，对照组466例）。Meta分析结果显示，与对照组相比，红霉素组胃内良好视野率（OR＾ = 4.82，P < 0.05）提高，二次内镜检查率降低（OR＾ = 0.42，P < 0.05），输血量减少（MD = -0.48，P < 0.05），住院时间缩短（MD = -1.41，P < 0.05）；内镜检查时间比较，差异无统计学意义（P > 0.05）。结论 UGIB患者内镜检查前注射红霉素，可明显改善内镜检查视野，减少二次内镜检查需求和输血量，缩短住院时间，值得临床应用。

Abstract:

Objective Erythromycin infusion before endoscopy in upper gastrointestinal bleeding (UGIB) could help remove residual blood and clots, provide a clearer view, but controversy still surrounded its validity and benefit, in order to objective evaluation,we performed a Meta-analysis comparing the efficacy of erythromycin infusion before endoscopy in acute UGIB.Methods We searched PubMed, Embase, The Cochrane Library, and CNKI databases from inception to Jan. 2022 to obtain randomized controlled trials (RCT) of erythromycin before endoscopy in UGIB patients to no erythromycin or placebo. Pooled estimates of satisfactory stomach visualization, need for second endoscopy, endoscopic duration, length of hospital stay and units of blood transfused using odds ratio (OR＾) or mean difference (MD) were calculated. Heterogeneity and publication bias were assessed.Results 12 RCT met the inclusion criteria, with a total number of 914 participants (448 in the erythromycin group and 466 in the control group). Erythromycin infusion before endoscopy in UGIB demonstrated a statistically significant improvement in visualization of the gastric mucosa (OR＾ = 4.82, P < 0.05) compared with no erythromycin. In addition, erythromycin infusion before endoscopy resulted in a statistically significant decrease in the need for a second endoscopy (OR＾ = 0.42, P < 0.05), units of blood transfused (MD = -0.48, P < 0.05), and the duration of hospital stay (MD = -1.41, P < 0.05). In addition, there was a trend to shorten the endoscopic duration, but the difference was not statistically significant.Conclusion Erythromycin infusion before endoscopy in patients with UGIB can significantly improve visualization, reduce the amount of secondary endoscopy and blood transfusion, shorten the length of hospital stay.