Candy Bridget, Jones Louise, Larkin Philip J, Vickerstaff Victoria, Tookman Adrian, Stone Patrick
Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, Charles Bell House, 67 - 73 Riding House Street, London, UK, W1W 7EJ.
Cochrane Database Syst Rev. 2015 May 13;2015(5):CD003448. doi: 10.1002/14651858.CD003448.pub4.
This article describes the second update of a Cochrane review on the effectiveness of laxatives for the management of constipation in people receiving palliative care. Previous versions were published in 2006 and 2010 where we also evaluated trials of methylnaltrexone; these trials have been removed as they are included in another review in press. In these earlier versions, we drew no conclusions on individual effectiveness of different laxatives because of the limited number of evaluations. This is despite constipation being common in palliative care, generating considerable suffering due to the unpleasant physical symptoms and the availability of a wide range of laxatives with known differences in effect in other populations.
To determine the effectiveness and differential efficacy of laxatives used to manage constipation in people receiving palliative care.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science (SCI & CPCI-S) for trials to September 2014.
Randomised controlled trials (RCTs) evaluating laxatives for constipation in people receiving palliative care.
Two authors assessed trial quality and extracted data. The appropriateness of combining data from the studies depended upon clinical and outcome measure homogeneity.
We identified five studies involving the laxatives lactulose, senna, co-danthramer, misrakasneham, docusate and magnesium hydroxide with liquid paraffin. Overall, the study findings were at an unclear risk of bias. As all five studies compared different laxatives or combinations of laxatives, it was not possible to perform a meta-analysis. There was no evidence on whether individual laxatives were more effective than others or caused fewer adverse effects.
AUTHORS' CONCLUSIONS: This second update found that laxatives were of similar effectiveness but the evidence remains limited due to insufficient data from a few small RCTs. None of the studies evaluated polyethylene glycol or any intervention given rectally. There is a need for more trials to evaluate the effectiveness of laxatives in palliative care populations. Extrapolating findings on the effectiveness of laxatives evaluated in other populations should proceed with caution. This is because of the differences inherent in people receiving palliative care that may impact, in a likely negative way, on the effect of a laxative.
本文介绍了Cochrane系统评价关于缓泻剂对姑息治疗患者便秘管理有效性的第二次更新。先前版本分别发表于2006年和2010年，在那些版本中我们还评估了甲基纳曲酮的试验；这些试验已被移除，因为它们已被纳入另一篇即将发表的综述中。在这些早期版本中，由于评估数量有限，我们未就不同缓泻剂的个体有效性得出结论。尽管便秘在姑息治疗中很常见，因其带来令人不适的身体症状而造成相当大的痛苦，并且有多种已知在其他人群中效果存在差异的缓泻剂可供使用。
确定用于管理姑息治疗患者便秘的缓泻剂的有效性和差异疗效。
我们检索了Cochrane对照试验中心注册库（CENTRAL；Cochrane图书馆）、MEDLINE、EMBASE、CINAHL和科学引文索引（SCI & CPCI - S），检索截至2014年9月的试验。
评估缓泻剂对姑息治疗患者便秘效果的随机对照试验（RCT）。
两位作者评估试验质量并提取数据。合并研究数据的恰当性取决于临床和结局指标的同质性。
我们识别出五项涉及乳果糖、番泻叶、复方丹曲林、密斯拉卡斯内哈姆、多库酯和氢氧化镁与液状石蜡的缓泻剂的研究。总体而言，研究结果存在偏倚风险不明的情况。由于所有五项研究比较的是不同的缓泻剂或缓泻剂组合，因此无法进行荟萃分析。没有证据表明个体缓泻剂是否比其他缓泻剂更有效或导致的不良反应更少。
本次第二次更新发现缓泻剂的有效性相似，但由于少数小型RCT的数据不足，证据仍然有限。没有研究评估聚乙二醇或任何直肠给药的干预措施。需要更多试验来评估缓泻剂在姑息治疗人群中的有效性。对在其他人群中评估的缓泻剂有效性的研究结果进行外推时应谨慎。这是因为姑息治疗患者存在的固有差异可能以一种可能负面的方式影响缓泻剂的效果。
