Traut U, Brügger L, Kunz R, Pauli-Magnus C, Haug K, Bucher H C, Koller M T
Cochrane Database Syst Rev. 2008 Jan 23(1):CD004930. doi: 10.1002/14651858.CD004930.pub3.
Postoperative adynamic bowel atony interferes with recovery following abdominal surgery. Prokinetic pharmacologic drugs are widely used to accelerate postoperative recovery.
To evaluate the benefits and harms of systemic acting prokinetic drugs to treat postoperative adynamic ileus in patients undergoing abdominal surgery.
Trials were identified by computerised searches of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the Cochrane Colorectal Cancer Group specialised register. The reference lists of included trials and review articles were tracked and authors contacted.
Randomised controlled parallel-group trials (RCT) comparing the effect of systemically acting prokinetic drugs against placebo or no intervention.
Four reviewers independently extracted the data and assessed trial quality. Trial authors were contacted for additional information if needed.
Thirty-nine RCTs met the inclusion criteria contributing a total of 4615 participants. Most trials enrolled a small number of patients and showed moderate to poor (reporting of) methodological quality, in particular regarding allocation concealment and intention-to-treat analysis. Fifteen systemic acting prokinetic drugs were investigated and ten comparisons could be summarized. Six RCTs support the effect of Alvimopan, a novel peripheral mu receptor antagonist. However, the trials do not meet reporting guidelines and the drug is still in an investigational stage. Erythromycin showed homogenous and consistent absence of effect across all included trials and outcomes. The evidence is insufficient to recommend the use of cholecystokinin-like drugs, cisapride, dopamine-antagonists, propranolol or vasopressin. Effects are either inconsistent across outcomes, or trials are too small and often of poor methodological quality. Cisapride has been withdrawn from the market due to adverse cardiac events in many countries. Intravenous lidocaine and neostigmine might show a potential effect, but more evidence on clinically relevant outcomes is needed. Heterogeneity among included trials was seen in 10 comparisons. No major adverse drug effects were evident.
AUTHORS' CONCLUSIONS: Alvimopan may prove to be beneficial but proper judgement needs adherence to reporting standards. Further trials are needed on intravenous lidocaine and neostigmine. The remaining drugs can not be recommended due to lack of evidence or absence of effect.
术后动力性肠梗阻会干扰腹部手术后的恢复。促动力药物被广泛用于加速术后恢复。
评估全身性促动力药物治疗腹部手术患者术后动力性肠梗阻的益处和危害。
通过计算机检索Cochrane对照试验中心注册库、MEDLINE、EMBASE以及Cochrane结直肠癌组专业注册库来识别试验。追踪纳入试验和综述文章的参考文献列表并联系作者。
比较全身性促动力药物与安慰剂或无干预措施效果的随机对照平行组试验（RCT）。
四位评价者独立提取数据并评估试验质量。如有需要，会联系试验作者获取更多信息。
39项RCT符合纳入标准，共纳入4615名参与者。大多数试验纳入的患者数量较少，方法学质量为中度至较差（报告方面），尤其是在分配隐藏和意向性分析方面。研究了15种全身性促动力药物，可总结出10项比较。六项RCT支持新型外周μ受体拮抗剂阿维莫潘的效果。然而，这些试验未符合报告指南，且该药物仍处于研究阶段。在所有纳入试验和结局中，红霉素均显示出一致且无效果。证据不足以推荐使用胆囊收缩素样药物、西沙必利、多巴胺拮抗剂、普萘洛尔或血管加压素。其效果在不同结局中不一致，或者试验规模太小且方法学质量往往较差。西沙必利在许多国家因心脏不良事件已退出市场。静脉注射利多卡因和新斯的明可能显示出潜在效果，但需要更多关于临床相关结局的证据。在10项比较中发现纳入试验之间存在异质性。未发现明显的主要药物不良反应。
阿维莫潘可能被证明有益，但需要遵循报告标准才能做出正确判断。需要对静脉注射利多卡因和新斯的明进行进一步试验。由于缺乏证据或无效果，其余药物无法推荐。
