活血化瘀中药注射液治疗肺血栓栓塞症有效性及安全性的Meta分析
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摘要
目的:评价活血化瘀中药注射液治疗肺血栓栓塞症的有效性及安全性。方法:系统检索CNKI、WANFANG DATA、VIP、SinoMed、EMbase、PubMed、The Cochrane Library,按照预先设定纳入与排除标准筛选随机对照临床试验,应用风险评估工具进行研究质量评价,提取数据并运用Revman 5.3软件进行Meta分析。共检索到413篇文献,纳入12个研究,总样本数为1005例,试验组503例和对照组502例。结果:在西医常规治疗的基础上联合活血化瘀中药注射液治疗肺血栓栓塞症,与单用西医治疗相比,能提高总有效率[RR=1.15,95%CI (1.07,1.24)];降低D-二聚体[SMD=-1.16,95%CI (-1.79,-0.53)];增加氧分压[MD=15.45,95%CI (8.62,22.29)];降低BNP[MD=-130.48,95%CI (-140.58,-120.38)];降低肺动脉压[MD=-6.55,95%CI (-8.85,-4.24)]。但两组二氧化碳分压(PaO_2)、肌钙蛋白(cTnI)差异无统计学意义(P>0.05)。不良反应较轻微。结论:活血化瘀中药注射液联合西医治疗肺血栓栓塞症,疗效优于单用西医治疗。但由于纳入研究质量偏低,研究结论仍有待更多高质量随机对照试验加以验证。
Objective: To evaluate the efficacy and safety of herb injections promoting blood circulation in the treatment of pulmonary thromboembolism. Method: The databases of Embase, PubMed, Cochrane Library, SinoMed, CNKI, VIP and WANFANG DATA were searched by computer, and randomized controlled trials were collected according to the preset inclusion criteria and exclusion criteria. Then risk assessment tools were used for quality evaluation of the studies, and data extraction and analysis were conducted by RevMan 5.3 software for Meta-analysis. A total of 413 articles were retrieved. And there were 12 RCTs enclosed involving 1005 patients, including 503 cases in experimental group and 502 cases in control group. Result: Compared with conventional medicine, herb injections promoting blood circulationshowed more efficiency[RR=1.15, 95% CI(1.07, 1.24)], reduced D-dimer [SMD=-1.16, 95% CI(-1.79,-0.53)]; increased PaO_2[MD=15.45, 95% CI(8.62, 22.29)]; reduced BNP [MD=-130.48, 95% CI(-140.58,-120.38)];ruduced pulmonary artery pressure [MD=-6.55, 95% CI(-8.85,-4.24)]. But there was no significant difference between the two groups in PaCO_2 and cTnI. The main adverse reactions reported were subcutaneous hemorrhage and rash. Conclusion: Integrated herb injections promoting blood circulation and western medicine showed more efficacy than conventional medicine in treatment of pulmonary thromboembolism. However, because of low-quality in the included studies, more high-quality randomized controlled trials would be needed in the future.
Objective: To evaluate the efficacy and safety of herb injections promoting blood circulation in the treatment of pulmonary thromboembolism. Method: The databases of Embase, PubMed, Cochrane Library, SinoMed, CNKI, VIP and WANFANG DATA were searched by computer, and randomized controlled trials were collected according to the preset inclusion criteria and exclusion criteria. Then risk assessment tools were used for quality evaluation of the studies, and data extraction and analysis were conducted by RevMan 5.3 software for Meta-analysis. A total of 413 articles were retrieved. And there were 12 RCTs enclosed involving 1005 patients, including 503 cases in experimental group and 502 cases in control group. Result: Compared with conventional medicine, herb injections promoting blood circulationshowed more efficiency[RR=1.15, 95% CI(1.07, 1.24)], reduced D-dimer [SMD=-1.16, 95% CI(-1.79,-0.53)]; increased PaO_2[MD=15.45, 95% CI(8.62, 22.29)]; reduced BNP [MD=-130.48, 95% CI(-140.58,-120.38)];ruduced pulmonary artery pressure [MD=-6.55, 95% CI(-8.85,-4.24)]. But there was no significant difference between the two groups in PaCO_2 and cTnI. The main adverse reactions reported were subcutaneous hemorrhage and rash. Conclusion: Integrated herb injections promoting blood circulation and western medicine showed more efficacy than conventional medicine in treatment of pulmonary thromboembolism. However, because of low-quality in the included studies, more high-quality randomized controlled trials would be needed in the future.
引文
[1] 中华医学会呼吸病学分会肺栓塞与肺血管病学组.肺血栓栓塞症诊治与预防指南[S].中华医学杂志,2018,98(14):1060-1087.
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[15] 张玉洁,高建敏.疏血通及溶栓联合抗凝疗法治疗肺栓塞及对患者血清肌钙蛋白及D二聚体的影响[J].浙江临床医学,2015(6):975-976.
[16] 冯辉.疏血通联合低分子肝素钠治疗急性肺栓塞的疗效观察[J].医药前沿,2011,1(20):52-53.
[17] 李军,王海英,章艳菊,等.疏血通注射液联合抗凝治疗中危肺栓塞31例临床评价[J].中国药业,2015,24(24):46-47.
[18] 任涛,丁礼仁,姜伟敏.血栓通注射液联合华法林、低分子肝素治疗急性肺血栓栓塞症的临床观察[J].中国药房,2014(44):4190-4192.
[19] 中华医学会心血管病分会肺血管病学组.急性肺血栓栓塞症诊断治疗中国专家共识[S].中华内科杂志,2010,49(1):74-81.
[20] 中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南:草案[S].中华结核和呼吸杂志,2001,24(5):259.
[21] 张春来,梁颖,左万里,等.尿激酶、低分子肝素和华法林的不同联合方案治疗肺栓塞的临床研究[J].临床合理用药,2011,4(7B):5-6.
[22] 陈羡人,张宗辉.丹红注射液治疗早期深静脉血栓形成50例观察[J].浙江中医杂志,2013,48(10):777.
[23] 杨杨,曾令霞.丹红注射液治疗脑梗死临床疗效和安全性的Meta分析[J].中华全科医师杂志,2012,11(5):372-375.
[24] 盛颖,曾令霞.丹红注射液治疗冠心病心绞痛疗效的Meta分析[J].中华全科医师杂志,2013,12(1):66-69.
[2] 静脉血栓栓塞症抗凝治疗微循环血栓防治共识专家组.静脉血栓栓塞症抗凝治疗微循环血栓防治专家共识[S].中华老年多器官疾病杂志,2017,16(4):241-244.
[3] Jiménez D,De MJ,Guijarro R,et al.Trends in the Management and Outcomes of Acute Pulmonary Embolism:Analysis From the RIETE Registry[J].Journal of the American College of Cardiology,2016,67(2):162-170.
[4] 杨精华,王俊峰.益肺和血通痹方治疗肺血栓栓塞症理论探析[J].亚太传统医药,2017,13(23):61-62.
[5] 韦云威.活血化瘀中药注射剂治疗肺栓塞的研究进展[J].临床合理用药杂志,2015(20):178-180.
[6] 中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南(草案)[S].中国临床医生杂志,2002,24(5):259-264.
[7] 余晓丹,李铮.丹参多酚酸盐联合降纤酶治疗急性次大面积肺血栓栓塞[J].血栓与止血学,2017,23(1):73-76.
[8] 阿丽亚·哈力克.丹参多酚酸盐注射液对血流动力学稳定肺栓塞的疗效[J].世界最新医学信息文摘,2015(54):78-79.
[9] 贺霞.丹红注射液联合低分子肝素治疗老年肺栓塞32例临床研究[J].中国药业,2015(4):29-30.
[10] 赵云.低分子肝素联合丹红注射液对肺栓塞疾病的治疗价值评析[J].中国实用医药,2016(3):112-113.
[11] 朱冰.低分子肝素联合丹红注射液治疗肺栓塞28例疗效观察[J].实用心脑肺血管病杂志,2008,16(2):134-135.
[12] 夏伟,肖卫,魏涵.低分子肝素联合丹红注射液治疗肺栓塞的临床疗效观察[J].中国医药指南,2015(12):68.
[13] 胡寒黎,胡小杰.低分子肝素联合丹红注射液治疗肺栓塞疗效观察[J].亚太传统医药,2014,10(10):108-109.
[14] 牧坤,徐亚东,李鑫,等.低分子肝素联合丹红注射液治疗老年肺栓塞疾病的疗效分析[J].中国实用医药,2017,12(36):120-121.
[15] 张玉洁,高建敏.疏血通及溶栓联合抗凝疗法治疗肺栓塞及对患者血清肌钙蛋白及D二聚体的影响[J].浙江临床医学,2015(6):975-976.
[16] 冯辉.疏血通联合低分子肝素钠治疗急性肺栓塞的疗效观察[J].医药前沿,2011,1(20):52-53.
[17] 李军,王海英,章艳菊,等.疏血通注射液联合抗凝治疗中危肺栓塞31例临床评价[J].中国药业,2015,24(24):46-47.
[18] 任涛,丁礼仁,姜伟敏.血栓通注射液联合华法林、低分子肝素治疗急性肺血栓栓塞症的临床观察[J].中国药房,2014(44):4190-4192.
[19] 中华医学会心血管病分会肺血管病学组.急性肺血栓栓塞症诊断治疗中国专家共识[S].中华内科杂志,2010,49(1):74-81.
[20] 中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南:草案[S].中华结核和呼吸杂志,2001,24(5):259.
[21] 张春来,梁颖,左万里,等.尿激酶、低分子肝素和华法林的不同联合方案治疗肺栓塞的临床研究[J].临床合理用药,2011,4(7B):5-6.
[22] 陈羡人,张宗辉.丹红注射液治疗早期深静脉血栓形成50例观察[J].浙江中医杂志,2013,48(10):777.
[23] 杨杨,曾令霞.丹红注射液治疗脑梗死临床疗效和安全性的Meta分析[J].中华全科医师杂志,2012,11(5):372-375.
[24] 盛颖,曾令霞.丹红注射液治疗冠心病心绞痛疗效的Meta分析[J].中华全科医师杂志,2013,12(1):66-69.