Jin Wei, Guo Xiaohui, Li Qingjie, Luo Xiaoqiong, Zhong Juan, Song Yang, Hou Weiwei, Guo Yucui, Li Yiwei, Luo Junping
Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan.
Chongqing Traditional Chinese Medicine Hospital, Chongqing.
Medicine (Baltimore). 2020 May;99(20):e20188. doi: 10.1097/MD.0000000000020188.
The Chinese herb da huang (DH) (Rhubarb) is commonly used for GIF intensive care unit (ICU)/pediatric intensive care unit (PICU) gastrointestinal failure (GIF) patients in China. However, the potential preventive and therapeutic effect of DH in these patients has not yet been studied systematically.
The aim of this study was to evaluate the preventive and therapeutic effects of DH in treating ICU/PICU GIF patients with the most recent evidence.
We systematically searched 7 databases from inception to March 30, 2018. RevMan 5.3 software was used to perform a meta-analysis. GRADE methodology was applied to evaluate the quality of evidence for each outcome. The review protocol was registered on PROSPERO (CRD42018092710) in advance.
Seven studies comprising 788 pediatric or adult participants were included in this analysis. Three indicators, including GIF occurrence rates (gastrointestinal mucosal hemorrhage, enteroplegia), multiple organ dysfunction syndrome (MODS)-related items (occurrence rates of MODS, mortality rates of MODS) and duration in the ICU was analyzed. The GIF occurrence rate meta-analysis result was (RR 0.47, CI 95% 0.37-0.60; P = .95); MODS related items indicator result was (RR 0.44, CI 95% 0.33-0.59; P = .41); ICU duration ICU result was (RR -2.87, CI 95% -3.53--2.21; P = .40). The safety of Chinese herb DH (Rhubarb) remains unclear.
Current evidence suggests that the Chinese herb rhubarb (DH) powder combined with Western medicine was inferior to Western medicine alone in terms of preventive and therapeutic effects in ICU/PICU patients in terms of decreasing GIF occurrence rates (gastrointestinal mucosal hemorrhage and enteroplegia), occurrence rates of MODS, mortality from MODS, and shortened duration time in the ICU/PICU. However, larger sample sizes and rigorously-designed studies are necessary to conclusively determine the association between DH powder and outcomes in ICU/PICU GIF patients.
中药大黄在中国常用于重症监护病房（ICU）/儿科重症监护病房（PICU）的胃肠功能衰竭（GIF）患者。然而，大黄对这些患者的潜在预防和治疗作用尚未得到系统研究。
本研究旨在利用最新证据评估大黄对ICU/PICU GIF患者的预防和治疗效果。
我们系统检索了从数据库建立至2018年3月30日的7个数据库。使用RevMan 5.3软件进行荟萃分析。采用GRADE方法评估每个结局的证据质量。该综述方案已提前在PROSPERO（CRD42018092710）上注册。
本分析纳入了7项研究，共788名儿童或成人参与者。分析了3项指标，包括GIF发生率（胃肠黏膜出血、肠麻痹）、多器官功能障碍综合征（MODS）相关项目（MODS发生率、MODS死亡率）以及在ICU的住院时间。GIF发生率的荟萃分析结果为（风险比0.47，95%置信区间0.37 - 0.60；P = 0.95）；MODS相关项目指标结果为（风险比0.44，95%置信区间0.33 - 0.59；P = 0.41）；ICU住院时间结果为（风险比 -2.87，95%置信区间 -3.53 - -2.21；P = 0.40）。中药大黄的安全性仍不明确。
目前的证据表明，在降低GIF发生率（胃肠黏膜出血和肠麻痹）、MODS发生率、MODS死亡率以及缩短ICU/PICU住院时间方面，中药大黄粉联合西药在ICU/PICU患者的预防和治疗效果上不如单纯西药。然而，需要更大样本量和设计严谨的研究来最终确定大黄粉与ICU/PICU GIF患者结局之间的关联。
