Wu Mengmeng, Jiang Shuaiyu, Lu Xiaoguang, Zhong Yilong, Song Yi, Fan Zhiwei, Kang Xin
Graduate School, Dalian University, Dalian.
Department of Emergency Medicine, Zhongshan Hospital, Dalian University, Dalian, China.
Medicine (Baltimore). 2021 Apr 23;100(16):e25598. doi: 10.1097/MD.0000000000025598.
Acute pancreatitis is the most common complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). There was no conclusion on the prevention of Post-ERCP Pancreatitis (PEP) by Lactated Ringer Solution.
The purpose of this meta analyses is to determine whether aggressive hydration with Lactated Ringer Solution reduced the incidence of PEP.
We retrieved randomized clinical trials comparing the preventive effects of aggressive hydration with Lactated Ringer Solution and standard hydration on PEP from PubMed, the Cochrane Library, Embase, the Web of Science, Clinical Trial.gov, Scopus database, CNKI, CQVIP and WanFang Data. Primary outcome was incidence of PEP. Secondary outcomes included incidence of hyperamylasemia, abdominal pain and adverse events.
Ten randomized controlled trials with 2200 patients were included in this meta-analysis. Meta-analysis showed that compared with standard hydration, aggressive hydration reduced the incidence of PEP (odds ratio [OR], 0.40; 95% confidence intervals [CI], 0.26-0.63; P < .0001). Compared with standard hydration, aggressive hydration also reduced the incidence of hyperamylasemia after ERCP (OR, 0.48; 95% CI, 0.38-0.60; P < .0001). There was significant difference between aggressive hydration and standard hydration in the incidence of abdominal pain (OR, 0.29; 95% CI, 0.11-0.73; P = .008). There was no difference in adverse events between aggressive hydration and standard hydration (OR, 0.93; 95% CI, 0.21-4.13; P = .93). Sensitivity analyses showed that neither alternative effect measures nor statistical models regarding heterogeneity affected the conclusions of this meta-analysis.
Aggressive hydration with Lactated Ringer Solution during perioperative period of ERCP can prevent PEP.
急性胰腺炎是内镜逆行胰胆管造影术（ERCP）最常见的并发症。关于乳酸林格液预防ERCP术后胰腺炎（PEP）尚无定论。
本荟萃分析的目的是确定积极静脉输注乳酸林格液是否能降低PEP的发生率。
我们从PubMed、Cochrane图书馆、Embase、科学网、Clinical Trial.gov、Scopus数据库、中国知网、维普资讯和万方数据中检索了比较积极静脉输注乳酸林格液与标准补液对PEP预防效果的随机临床试验。主要结局是PEP的发生率。次要结局包括高淀粉酶血症、腹痛和不良事件的发生率。
本荟萃分析纳入了10项随机对照试验，共2200例患者。荟萃分析表明，与标准补液相比，积极静脉输注乳酸林格液可降低PEP的发生率（比值比[OR]，0.40；95%置信区间[CI]，0.26 - 0.63；P＜0.0001）。与标准补液相比，积极静脉输注乳酸林格液还可降低ERCP术后高淀粉酶血症的发生率（OR，0.48；95%CI，0.38 - 0.60；P＜0.0001）。积极静脉输注乳酸林格液与标准补液在腹痛发生率方面存在显著差异（OR，0.29；95%CI，0.11 - 0.73；P = 0.008）。积极静脉输注乳酸林格液与标准补液在不良事件方面无差异（OR，0.93；95%CI，0.21 - 4.13；P = 0.93）。敏感性分析表明，无论是替代效应量还是关于异质性的统计模型均未影响本荟萃分析的结论。
在ERCP围手术期积极静脉输注乳酸林格液可预防PEP。
