Moazzami Bobak, Mohammadpour Zinat, Zabala Zohyra E, Chawla Saurabh
Internal Medicine, Graduate Medical Education-Northside Hospital Gwinnett, Lawrenceville, GA.
College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
Pancreas. 2025 Apr 1;54(4):e369-e377. doi: 10.1097/MPA.0000000000002444.
Acute pancreatitis (AP) can lead to severe complications and high mortality. Previous studies suggest that epidural analgesia (EA) may improve outcomes in AP. This systematic review and meta-analysis aimed to evaluate the efficacy of EA on in-hospital outcomes in AP patients.
Electronic databases (PubMed, Medline-Ovid, Scopus, CINAHL, Web of Science) were systematically searched until May 2024 for RCTs comparing EA with other pain strategies in AP patients. Variables were pooled using weighted mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Data analysis employed random-effects the Mantel-Haenszel method and I 2 statistic was used for heterogeneity.
Five RCTs with 260 participants were included. Meta-analysis showed no significant differences in in-hospital mortality (RR, 0.69; 95% CI [0.29-1.65]; P = 0.40), mechanical ventilation (RR, 0.82; 95% CI [0.61-1.10]; P = 0.19), sepsis (RR, 0.88; 95% CI [0.42-1.86]; P = 0.74), hospital/ICU stay (WMD, 0.49 days; 95% CI [-1.13 to 2.10]; P = 0.55), and pain score (WMD, 1.49; 95% CI [-0.42 to 3.40]; P = 0.13). Opioid requirements were significantly lower, with one study reporting MME of 15 mg/d compared to 52 mg/d in the control group ( P = 0.001). Heterogeneity was low to moderate for most outcomes but high for pain score ( I2 = 92%). Small number of studies, risk of bias, and sample size limited overall certainity.
EA did not significantly improve in-hospital outcomes in AP patients. However, findings suggested potential benefits in pain management. High-quality randomized trials are needed to understand the potential benefits of EA in this population.
急性胰腺炎（AP）可导致严重并发症和高死亡率。既往研究表明，硬膜外镇痛（EA）可能改善AP患者的预后。本系统评价和荟萃分析旨在评估EA对AP患者院内结局的疗效。
系统检索电子数据库（PubMed、Medline - Ovid、Scopus、CINAHL、Web of Science）至2024年5月，以查找比较EA与其他疼痛管理策略在AP患者中的随机对照试验（RCT）。使用加权平均差（WMD）或风险比（RR）及95%置信区间（CI）对变量进行汇总。数据分析采用随机效应的Mantel - Haenszel方法，并用I²统计量评估异质性。
纳入5项RCT，共260名参与者。荟萃分析显示，在院内死亡率（RR = 0.69；95%CI [0.29 - 1.65]；P = 0.40）、机械通气（RR = 0.82；95%CI [0.61 - 1.10]；P = 0.19）、脓毒症（RR = 0.88；95%CI [0.42 - 1.86]；P = 0.74）、住院/重症监护病房（ICU）住院时间（WMD = 0.49天；95%CI [-1.13至2.10]；P = 0.55）和疼痛评分（WMD = 1.49；95%CI [-0.42至3.40]；P = 0.13）方面无显著差异。阿片类药物需求量显著较低，一项研究报告试验组平均每日吗啡毫克当量（MME）为15 mg/d，而对照组为52 mg/d（P = 0.001）。大多数结局的异质性为低到中度，但疼痛评分的异质性较高（I² = 92%）。研究数量少、偏倚风险和样本量限制了总体确定性。
EA未显著改善AP患者的院内结局。然而，研究结果提示在疼痛管理方面可能存在益处。需要高质量随机试验来了解EA在此类患者中的潜在益处。
