癌症患者阿片类药物引起和非阿片类药物相关便秘的管理：系统评价和荟萃分析。
Management of Opioid-Induced and Non-Opioid-Related Constipation in Patients With Cancer: Systematic Review and Meta-Analysis.
机构信息
Oncology Nursing Society.
University of Minnesota, Veteran's Affairs Healthcare.
出版信息
Oncol Nurs Forum. 2020 Nov 1;47(6):E211-E224. doi: 10.1188/20.ONF.E211-E224.
PROBLEM IDENTIFICATION
A systematic review and meta-analysis was conducted to inform the development of national clinical practice guidelines on the management of cancer constipation.
LITERATURE SEARCH
PubMed®, Wiley Cochrane Library, and CINAHL® were searched for studies published from May 2009 to May 2019.
DATA EVALUATION
Two investigators independently reviewed and extracted data from eligible studies. The Cochrane Collaboration risk-of-bias tool was used, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence.
SYNTHESIS
For patients with cancer and opioid-induced constipation, moderate benefit was found for osmotic or stimulant laxatives; small benefit was found for methylnaltrexone, naldemedine, and electroacupuncture. For patients with cancer and non-opioid-related constipation, moderate benefit was found for naloxegol, prucalopride, lubiprostone, and linaclotide; trivial benefit was found for acupuncture.
IMPLICATIONS FOR PRACTICE
Effective strategies for managing opioid-induced and non-opioid-related constipation in patients with cancer include lifestyle, pharmacologic, and complementary approaches.
SUPPLEMENTAL MATERIAL CAN BE FOUND AT HTTPS: //bit.ly/3c4yewT.
问题识别
为了为制定癌症便秘管理的国家临床实践指南提供信息，进行了系统评价和荟萃分析。
文献检索
在 2009 年 5 月至 2019 年 5 月期间，检索了 PubMed®、Wiley Cochrane Library 和 CINAHL®上发表的研究。
数据评估
两名调查员独立审查并从合格研究中提取数据。使用 Cochrane 协作风险偏倚工具，并使用 GRADE（推荐评估、制定和评估分级）方法评估证据的确定性。
综合
对于癌症合并阿片类药物诱导性便秘的患者，发现渗透性或刺激性泻药有中度获益；甲基纳曲酮、那洛美丁和电针有小的获益。对于癌症合并非阿片类相关便秘的患者，发现纳洛酮、普芦卡必利、鲁比前列酮和利那洛肽有中度获益；针灸有微小的获益。
实践意义
管理癌症患者阿片类药物诱导性和非阿片类相关便秘的有效策略包括生活方式、药物和补充方法。
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