肾上腺素和去甲肾上腺素治疗非静脉曲张性上消化道出血疗效和安全性的Meta分析

Effectiveness and safety of epinephrine and norepinephrine for treating non-variceal upper gastrointestinal bleeding: a meta-analysis

摘要:

目的 系统评价肾上腺素注射和去甲肾上腺素喷洒对于非静脉曲张性上消化道出血的疗效和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、CNKI、CBM、维普、万方数据库，检索时限为建库至 2018年 12月，搜集肾上腺素注射和去甲肾上腺素喷洒治疗上消化道出血的相关临床研究，同时对纳入研究的参考文献进行回溯补充。由 2 位研究者独立进行文献筛选、资料提取、纳入研究偏倚风险评价，采用 RevMan 5.3 软件进行 Meta 分析，并按照推荐分级的评估、制定与评价（GRADE）系统进行证据质量评价。结果 最终纳入10项研究，包含884例受试者。Meta 分析结果显示肾上腺素注射治疗非静脉曲张性上消化道出血在以下4方面均优于去甲肾上腺素喷洒治疗：有效率（RR=1.21，95%CI：1.12~1.30，P＜0.001）；一周再出血率（RR=0.28，95%CI：0.17~0.45，P＜0.001）；即时止血率（RR=1.38，95%CI：1.25~1.52，P＜0.001）；急诊手术率（RR=0.35，95%CI：0.19~0.63，P＜0.001），差异均有统计学意义。结论 肾上腺素注射治疗非静脉曲张性上消化道出血疗效与安全性明显优于去甲肾上腺素喷洒治疗。

Abstract:

Objective To systematically evaluate the effectiveness and safety of epinephrine injection and norepinephrine spraying for treating non-variceal upper gastrointestinal bleeding. Methods Databases including the PubMed, Embase, Cochrane Library, CNKI, CBM, VIP and WanFang Data with the retrieval time from inception to December 2018 were searched to collect the related clinical trials. The references of included studies were also retrieved. Studies were screened, data were extracted, and the risk of bias was assessed by 2 reviewers separately. The meta-analysis was conducted by using RevMan 5.3 software. The grading of recommendations, assessment, development and evaluation (GRADE) quality of evidence system was used to assess the results of meta-analysis. Results A total of 10 studies involving 884 participants were included. The results showed that compared with the norepinephrine spraying, epinephrine injection was superior in the following aspects with significant differences: the effective rate (RR=1.21， 95%CI： 1.12-1.30， P＜0.001); the one-week recurrent bleeding rate (RR=0.28， 95%CI： 0.17-0.45， P＜0.001); the immediate hemostatic rate (RR=1.38， 95%CI： 1.25-1.52， P＜0.001); and the emergent operation rate (RR=0.35， 95%CI： 0.19-0.63， P＜0.001). Conclusion Epinephrine injection is more effective and safer for treating non-variceal upper gastrointestinal bleeding in comparison with norepinephrine spraying.