目的 系統(tǒng)評(píng)價(jià)不同劑量奧曲肽治療重癥急性胰腺炎（SAP）的有效性和安全性。方法 計(jì)算機(jī)檢索PubMed、Embase、Cochrane Library、Science Direct、中國(guó)期刊全文數(shù)據(jù)庫（CNKI）、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、維普生物醫(yī)學(xué)數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫，收集奧曲肽高劑量（1.2 mg/d）對(duì)比低劑量（0.6 mg/d）治療SAP的病例對(duì)照研究，采用RevMan 5.3軟件進(jìn)行Meta分析。結(jié)果 共納入12篇文獻(xiàn)，901例SAP患者，其中低劑量組450例、高劑量組451例。Meta分析結(jié)果顯示：相較于低劑量組，高劑量組顯著提高總有效率（RR=1.17，95% CI=1.10～1.24，P<0.01）、減少并發(fā)癥發(fā)生率（RR=0.36，95% CI=0.22～0.58，P<0.01）、縮短血淀粉酶恢復(fù)正常時(shí)間（MD=-1.72，95% CI=-1.98～-1.45，P<0.01）和腹痛消失時(shí)間（MD=-1.90，95% CI=-2.04～-1.76，P<0.01）；高劑量組和低劑量組病死率分別為3.74%和8.56%，中轉(zhuǎn)手術(shù)率分別為13.24%和19.87%，不良反應(yīng)發(fā)生率分別為11.16%和9.87%，差異均無統(tǒng)計(jì)學(xué)意義。結(jié)論 高劑量（1.2 mg/d）奧曲肽治療SAP的臨床有效率、減少并發(fā)癥、縮短血淀粉酶恢復(fù)時(shí)間和腹痛消失時(shí)間明顯優(yōu)于低劑量（0.6 mg/d），但降低死亡率和中轉(zhuǎn)手術(shù)率未見明顯優(yōu)勢(shì)。

Objective To systematically evaluate the efficacy and safety of different does octreotide on severe acute pancreatitis (SAP). Methods Databases including PubMed, Embase, the Cochrane Library, Science Direct, CNKI, CBM, VIP and Wanfang Data were searched to collect the controlled trials of octreotide with high-does (1.2 mg/d) versus low-does (0.6 mg/d) on the SAP. The RevMan 5.3 software was used to carry out the Meta-analysis. Results A total of 12 literatures and 901 patients were included in this study, including 451 patients in high-does group and 450 patients in low-does group. Meta-analysis results showed that, compared with the low-dose group, the high-dose group was significantly increased in the clinical effective rate (RR=1.17,95%CI=1.10-1.24,P<0.01), significantly reduced the complication rate (RR=0.36, 95%CI=0.22-0.58, P<0.01); significantly reduced the time of blood amylase return to normal (MD=-1.72, 95%CI=-1.98--1.45, P<0.01) and abdominal pain disappear (MD=-1.90, 95%CI=-2.04--1.76, P<0.01). The fatality rates of the high-dose group and low-dose group respectively were 3.74% and 8.56%, the transfer rate respectively were 13.24% and 19.87%, the ADR rate respectively were 11.16% and 9.87%, and the difference was not statistically significant. Conclusion The high dose octreotide in the treatment of SAP is significantly better than the low dose in the clinical effectiveness, reduction of complications, reduction of blood amylase recovery time and disappearance of abdominal pain, but there is no significant advantage in the reduction of mortality and conversion rate to surgery.

R977