Tan J J Y, Tjandra J J
Department of Colorectal Surgery, Royal Melbourne Hospital and Epworth Colorectal Centre, Melbourne, Australia.
Colorectal Dis. 2006 May;8(4):247-58. doi: 10.1111/j.1463-1318.2006.00970.x.
To assess which bowel preparation agent is most effective.
A search of randomized trials between January 1990 and July 2005 was obtained, using MEDLINE and PubMed databases, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using the Forest plot review.
Sodium phosphate (NaP) was more effective in bowel cleansing than polyethylene glycol (PEG) - odds ratio 0.75 (95%CI: 0.65-0.88; P = 0.0004); and sodium picosulphate (SPS) - odds ratio 0.52 (95%CI: 0.34-0.81; P = 0.004). PEG and SPS were comparable in bowel cleansing ability, odds ratio 1.69 (95%CI: 0.92-3.13; P = 0.09). NaP was more easily completed by patients compared to PEG, odds ratio 0.16 (95%CI: 0.09-0.29; P < 0.00001). More patients were able to complete SPS than PEG, but this was not statistically significant - odds ratio 0.56 (95%CI: 0.28-1.13; P = 0.11). NaP and PEG were comparable in terms of adverse events, odds ratio 0.98 (95%CI: 0.82-1.17; P = 0.81), although NaP resulted in more asymptomatic hypokalaemia and hyperphosphataemia. NaP and SPS appeared to have similar incidence of adverse events. PEG resulted in more adverse events than SPS, odds ratio 3.82 (95%CI: 1.60-9.15; P = 0.003).
NaP was more effective in bowel cleansing than PEG or SPS and was comparable in terms of adverse events. Patients have more difficulty completing PEG than NaP and SPS. Biochemical changes associated with a small-volume preparation like NaP, albeit largely asymptomatic, mandate caution in patients with cardiovascular or renal impairment.
评估哪种肠道准备剂最有效。
利用MEDLINE和PubMed数据库以及Cochrane对照试验中央注册库，检索1990年1月至2005年7月间的随机试验。采用森林图回顾进行荟萃分析。
磷酸钠（NaP）在肠道清洁方面比聚乙二醇（PEG）更有效——比值比为0.75（95%置信区间：0.65 - 0.88；P = 0.0004）；比匹可硫酸钠（SPS）更有效——比值比为0.52（95%置信区间：0.34 - 0.81；P = 0.004）。PEG和SPS在肠道清洁能力方面相当，比值比为1.69（95%置信区间：0.92 - 3.13；P = 0.09）。与PEG相比，患者完成NaP更容易，比值比为0.16（95%置信区间：0.09 - 0.29；P < 0.00001）。能够完成SPS的患者比完成PEG的多，但这无统计学意义——比值比为0.56（95%置信区间：0.28 - 1.13；P = 0.11）。NaP和PEG在不良事件方面相当，比值比为0.98（95%置信区间：0.82 - 1.17；P = 0.81），尽管NaP导致更多无症状性低钾血症和高磷血症。NaP和SPS的不良事件发生率似乎相似。PEG导致的不良事件比SPS多，比值比为3.82（95%置信区间：1.60 - 9.15；P = 0.003）。
NaP在肠道清洁方面比PEG或SPS更有效，且在不良事件方面相当。患者完成PEG比完成NaP和SPS更困难。与NaP这种小容量制剂相关的生化变化，尽管大多无症状，但对于有心血管或肾功能损害的患者需谨慎。
