长期肠梗阻是胃肠道手术后常见的并发症,发病率高达40%。研究肠梗阻的药物治疗的研究被证明在很大程度上令人失望;然而,最近,一些化合物已被证明在用作预防肠梗阻时受益.
这篇综述旨在评估最近开发或重新用于减少肠道恢复时间的化合物的安全性和有效性,从而防止肠梗阻。
数据来自MEDLINE的系统评价,EMBASE和Cochrane图书馆数据库,除了手动搜索参考列表,直到2015年4月。没有应用限制。
只有随机试验符合纳入条件。
阿片受体拮抗剂,ghrelin受体激动剂和5-羟色胺受体激动剂用于预防胃肠外科术后肠梗阻。
第一次排便时间的结果,首次肛门排气和复合肠恢复终点(GI2和GI3)用于确定疗效.汇总的治疗效果以标准平均差或风险比以及相应的95%置信区间表示。使用Cochrane偏差风险框架评估偏差风险。
共有17项研究纳入最终分析。μ阿片受体拮抗剂alvimopan和5-羟色胺受体激动剂似乎显着缩短了肠梗阻的持续时间。在5项试验中,使用Ghrelin受体激动剂似乎没有任何效果。未检测到发表偏倚。
大多数试验报道不充分,质量参差不齐。未来的研究必须集中在一组核心结果的发展。
有证据强烈建议在胃肠大手术中使用alvimopan以减少术后肠梗阻。需要进一步的随机试验来确定是否使用5-羟色胺受体激动剂。确定一种低成本的化合物以促进手术后的肠道恢复可以减少并发症并缩短住院时间。
Prolonged ileus is a common complication following gastrointestinal surgery, with an incidence of up to 40 %. Investigations examining pharmacological treatment of ileus have proved largely disappointing; however, recently, several compounds have been shown to have benefited when used as prophylaxis to prevent ileus.
This
review aimed to evaluate the safety and efficacy of compounds which have been recently developed or repurposed to reduce bowel recovery time, thereby preventing ileus.
Data were taken from a systematic
review of the MEDLINE, EMBASE and Cochrane Library Databases, in addition to manual searching of reference lists up to April 2015. No limits were applied.
Only randomized trials were eligible for inclusion.
Opioid receptor antagonists, ghrelin receptor agonists and serotonin receptor agonists used for the prevention of postoperative ileus in gastrointestinal surgery.
Outcomes of time to first defecation, first flatus and composite bowel recovery endpoints (GI2 and GI3) were used to determine efficacy. Pooled treatment effects were presented as the standard mean difference or as hazard ratios alongside the corresponding 95 % confidence intervals. Risk of bias was assessed using the Cochrane risk of bias framework.
A total of 17 studies were included in the final analysis. The μ-opioid receptor antagonist alvimopan and serotonin receptor agonists appeared to significantly shorten the duration of ileus. The use of Ghrelin receptor agonists did not appear to have any effect in five trials. No publication bias was detected.
Most of the trials were poorly reported and of mixed quality. Future studies must focus on the development of a set of core outcomes.
There is evidence to make a strong recommendation for the use of alvimopan in major gastrointestinal surgery to reduce postoperative ileus. Further randomized trials are required to establish whether serotonin receptor agonists are of use. Identifying a low-cost compound to promote bowel recovery following surgery could reduce complications and shorten duration of hospital admissions.