清胰汤类方不同给药途径治疗重症急性胰腺炎疗效指标的网状Meta分析OA

Objective:To evaluate the efficacy and safety of different administration routes of Qingyi Tang(清胰汤)-like prescriptions in the treatment of severe acute pancreatitis(SAP)using network meta-analysis.Methods:Computerized searches were conducted in PubMed,EMbase,Cochrane,Web of Science,CNKI,Wanfang,China Biology Medicine disc,and VIP databases from the establishment of each database to August 20,2025.The quality of the included studies was evaluated using the modified Jadad scale and the Cochrane risk of bias tool.Data analysis was performed using RevMan 5.4 and Stata 18 software.The primary outcome measures were clinical efficacy,mortality,and acute inflammatory response and intestinal function indicators.The secondary outcome measure was the time for blood amylase to return to normal.The surface under the cumulative ranking curve(SUCRA)was used to rank the intervention measures,and funnel plots were used to test for publication bias.Results:A total of 59 studies involving 4 588 patients were included,all of which were two-arm trials covering five treatment regimens:conventional Western medicine,conventional Western medicine combined with gastric tube administration of Qingyi Decoction,conventional Western medicine combined with gastric tube administration or enema of Qingyi Decoction,conventional Western medicine combined with nasojejunal tube feeding of Qingyi Decoction,and conventional Western medicine combined with enema of Qingyi Decoction.The analysis covered five indicators:clinical effective rate,time to first defecation,intestinal function recovery time,blood amylase recovery time,and mortality,with 33,40,33,19 and 19 reports respectively.Compared with conventional Western medicine alone,combined treatment with Qingyi Decoction significantly improved the clinical effective rate,shortened various recovery times,and reduced mortality.Different administration routes had distinct advantages.SUCRA ranking indicated that nasojejunal tube feeding was optimal for improving the effective rate and promoting intestinal function recovery,gastric tube administration combined with enema performed best in shortening the time to first defecation,nasojejunal tube feeding accelerated intestinal function recovery most rapidly,and gastric tube administration facilitated blood amylase recovery and yielded the lowest mortality.Conclusion:The combination of different administration routes of Qingyi Tang-like formula and conventional Western medical treatment measures in the treatment of SAP has obvious advantages in improving the clinical effective rate,shortening the first defecation time,intestinal function recovery time and amylase recovery time,and reducing the mortality rate.It can be used as one of the clinical treatment plans of integrated traditional Chinese and Western medicine.Due to the limitations of the sample size,quality of the included studies,and the lack of more specific direct pairwise comparisons of traditional Chinese medicine administration routes and outcome indicators,the above conclusions need to be further verified by more high-quality,large-sample,and multi-center clinical randomized controlled trials in future research.