中药足浴治疗糖尿病足高危足临床疗效的meta分析
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摘要
目的:系统评价中药足浴法治疗糖尿病高危足的临床疗效,对该方法的证据质量进行GRADE评级。方法:计算机检索数据库发表的有关中药足浴干预Wagner 0级糖尿病足的文献,检索时间均为建库至2017年3月。经过筛选文献、提取研究资料、系统评价后,对所纳入的研究进行GRADE证据质量评价。结果:共纳入26篇RCT研究,试验组1 236例,对照组1 163例。meta分析显示,中药足浴法治疗糖尿病高危足效果的总有效率优于对照组,差异具有统计学意义[OR=4.84,95%CI(3.86,6.07),P<0.000 01]。GRADE证据级别为中等质量。结论:中药足浴法干预糖尿病足Wagner 0级的效果优于常规西药治疗或单纯温水足浴。
Objective: To systematically review clinical efficacy of Chinese medicine intervention for the treatment of diabetic foot and to perform a GRADE analysis based on the quality of the evidence approach. Methods: The literature on Wagner-class 0 diabetic foot was retrieved by searching internet databases from the database establishment to March, 2017. GRADE evidence quality rating was conducted after screening the literature, extracting the research data and methodological evaluation for the included studies. Results: A total of 26 RCT(randomized controlled trial) studies were finally included, in which there were 1 236 cases in the trial group and 1 163 cases in the control group. Meta-analysis showed that the total effective rate of Wagner 0 level intervention by foot bath of TCM was better than that of control group [OR=4.84, 95% CI(3.86, 6.07), P<0.000 01] and GRADE level of evidence was medium quality. Conclusion: Curative efficacy of Chinese medicine foot bath for the intervention of Wagner 0 level of diabetic foot is much better than that of conventional wester medicine and simple warm water foot bath.
Objective: To systematically review clinical efficacy of Chinese medicine intervention for the treatment of diabetic foot and to perform a GRADE analysis based on the quality of the evidence approach. Methods: The literature on Wagner-class 0 diabetic foot was retrieved by searching internet databases from the database establishment to March, 2017. GRADE evidence quality rating was conducted after screening the literature, extracting the research data and methodological evaluation for the included studies. Results: A total of 26 RCT(randomized controlled trial) studies were finally included, in which there were 1 236 cases in the trial group and 1 163 cases in the control group. Meta-analysis showed that the total effective rate of Wagner 0 level intervention by foot bath of TCM was better than that of control group [OR=4.84, 95% CI(3.86, 6.07), P<0.000 01] and GRADE level of evidence was medium quality. Conclusion: Curative efficacy of Chinese medicine foot bath for the intervention of Wagner 0 level of diabetic foot is much better than that of conventional wester medicine and simple warm water foot bath.
引文
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[2]Wagner FW Jr.The dysvascular foot:a system for diagnosis and treatment[J].Foot Ankle,1981,2(2):64-122.
[3]Boulton AJM.Foot problems in patients with diabetes mellitus[M]//Pickup J,Williams G.Textbook of diabetes.2nd ed.London:Blackwell,1997:1-20.
[4]许樟荣.于世界糖尿病日重谈糖尿病足的诊治与预防[J].中华内分泌代谢杂志,2005,21(6):491-493.
[5]杨川.《国际糖尿病足工作组糖尿病足的预防指南》要点选译[J].糖尿病天地(临床),2015,9(10):498-502.
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[15]魏燕,叶迅,胡卫芬,等.中药足浴和凯时治疗糖尿病足106例疗效观察[J].浙江中医药大学学报,2006,30(5):477-478,480.
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[19]唐杏,陈青青,章旭萍.三虫桃红汤足浴治疗0级糖尿病足的疗效观察[J].浙江中医药大学学报,2014,38(5):651-653.
[20]谭小欣,曹飞,康小红.中西医结合治疗0级糖尿病足疗效观察及护理[J].中国误诊学杂志,2007,7(29):6996-6997.
[21]邱卫清,张军.中药足浴联合足部穴位按摩治疗糖尿病足的疗效观察[J].心脑血管病防治,2015,15(3):248-249.
[22]祁文辉.祛瘀通脉汤内服外洗治疗早期糖尿病足临床观察[J].山西中医,2014,30(2):39-40.
[23]罗艳.中药足浴与足底按摩治疗早期糖尿病神经病变60例观察[J].浙江中医杂志,2013,48(6):425.
[24]李清云.活血通络方足浴配合护理干预在糖尿病足0级患者中的应用效果[J].临床合理用药杂志,2016,9(3):119-120.
[25]景金霞,任秀喜,刘玉文.中药足浴法护理0级糖尿病足的临床观察[J].河北中医,2010,32(11):1730-1731.
[26]金真,林明欣,林燕玲,等.运用中医外治三联模式治疗0级糖尿病足40例临床观察[J].中华中医药杂志,2013,28(2):443-446.
[27]简小兵,王文英,戴莲仪,等.温阳养血活血通络法治疗0级糖尿病足的疗效观察[J].四川中医,2007,25(7):89-90.
[28]黄艳.中药泡足治疗糖尿病高危足的疗效观察及护理体会[J].广西中医药,2011,34(1):16-17.
[29]洪燕辉.中药泡足联合西药治疗护理糖尿病足[J].实用中医内科杂志,2013,27(6):125-126.
[30]管玉香,陈玉凤,汪莉.中药足部熏洗联合足底穴位按摩对0级糖尿病足的干预效应[J].中医药临床杂志,2011,23(12):1098-1099.
[31]丁福艳,张建波,王林娟,等.足浴结合中医护理对0级糖尿病足的疗效观察[J].中国中医药现代远程教育,2016,14(20):113-114.
[32]陈焱.中药熏洗治疗糖尿病足0级31例[J].中医研究,2007,20(2):40-41.
[33]陈青青.0级糖尿病足三虫桃红汤足浴联合足底反射区按摩的疗效观察[J].护理学报,2014,21(12):61-62.
[34]曾肃英.中药浴足配合艾灸足底穴位按摩对Wagner 0级糖尿病足疗效观察[J].糖尿病新世界,2014,34(9):25-26.
[35]曾庆伟.中药熏足对0级糖尿病足40例疗效观察[J].北方药学,2015,12(1):86,23.
[36]贾书冰,赵明沂,梁露花,等.漏斗图在meta分析中的正确使用研究[J].数理医药学杂志,2013,26(4):402-405.
[37]Guyatt GH,Oxman AD,Montori V,et al.GRADE指南:Ⅴ.证据质量评价--发表偏倚[J].中国循证医学杂志,2011,11(12):1430-1434.
[38]郭建平.中药足浴治疗糖尿病足85例临床观察[J].实用中医内科杂志,2006,20(1):74-75.
[39]Gordon G,Oxman AD,Akl E,et al.GRADE指南:Ⅰ.导论--GRADE证据概要表和结果总结表[J].中国循证医学杂志,2011,11(4):437-445.
[40]Balshem H,Helfanda M,Schunemann HJ,et al.GRADE指南:Ⅲ.证据质量分级[J].中国循证医学杂志,2011,11(4):451-455.
[2]Wagner FW Jr.The dysvascular foot:a system for diagnosis and treatment[J].Foot Ankle,1981,2(2):64-122.
[3]Boulton AJM.Foot problems in patients with diabetes mellitus[M]//Pickup J,Williams G.Textbook of diabetes.2nd ed.London:Blackwell,1997:1-20.
[4]许樟荣.于世界糖尿病日重谈糖尿病足的诊治与预防[J].中华内分泌代谢杂志,2005,21(6):491-493.
[5]杨川.《国际糖尿病足工作组糖尿病足的预防指南》要点选译[J].糖尿病天地(临床),2015,9(10):498-502.
[6]Bus SA,Van Netten JJ,Lavery LA,et al.IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes[J].Diabetes Metab Res Rev,2016,32(Suppl 1):16-24.
[7]Woo MJ,Ha YS,Lee JN,et al.Comparison of surgical outcomes between holmium laser enucleation and transurethral resection of the prostate in patients with detrusor underactivity[J].Int Neurourol J,2017,21(1):46-52.
[8]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions version 5.1.0[M].New Jersey:WileyBlackwell,2011.
[9]Schünemann H,Brozk J,Oxman AE,et al.GRADEhand-book for grading quality of evidence and strength of recommendation[M].Norway:GRADE Working Group,2009.
[10]钟润芬,刘鹏,周卓宁.凯时注射液加中药泡足治疗糖尿病高危足36例疗效观察[J].广西医学,2007,29(12):1945.
[11]于永红.中西药联合治疗早期糖尿病足的临床研究[J].中国现代药物应用,2013,7(11):122-123.
[12]叶育双.中药外洗方治疗早期糖尿病足35例[J].浙江中西医结合杂志,2014,24(10):918-919.
[13]叶海东,曹岐新.中药足浴治疗0级糖尿病足50例临床观察[J].浙江中医杂志,2014,49(7):519-520.
[14]徐延平,李彦华.中西医结合治疗糖尿病足的疗效观察[J].中国现代医生,2008,46(35):73-74.
[15]魏燕,叶迅,胡卫芬,等.中药足浴和凯时治疗糖尿病足106例疗效观察[J].浙江中医药大学学报,2006,30(5):477-478,480.
[16]王竹风,汪宝军,马力.中西医结合治疗糖尿病高危足临床观察[J].中国中医药信息杂志,2010,17(1):53-54.
[17]王宇,王秀玲,张家佳,等.0级糖尿病足的中药护理观察[J].中医临床研究,2012,4(7):95-96.
[18]王小强.中药足浴治疗糖尿病足130例疗效观察[J].中医药导报,2011,17(12):40-41.
[19]唐杏,陈青青,章旭萍.三虫桃红汤足浴治疗0级糖尿病足的疗效观察[J].浙江中医药大学学报,2014,38(5):651-653.
[20]谭小欣,曹飞,康小红.中西医结合治疗0级糖尿病足疗效观察及护理[J].中国误诊学杂志,2007,7(29):6996-6997.
[21]邱卫清,张军.中药足浴联合足部穴位按摩治疗糖尿病足的疗效观察[J].心脑血管病防治,2015,15(3):248-249.
[22]祁文辉.祛瘀通脉汤内服外洗治疗早期糖尿病足临床观察[J].山西中医,2014,30(2):39-40.
[23]罗艳.中药足浴与足底按摩治疗早期糖尿病神经病变60例观察[J].浙江中医杂志,2013,48(6):425.
[24]李清云.活血通络方足浴配合护理干预在糖尿病足0级患者中的应用效果[J].临床合理用药杂志,2016,9(3):119-120.
[25]景金霞,任秀喜,刘玉文.中药足浴法护理0级糖尿病足的临床观察[J].河北中医,2010,32(11):1730-1731.
[26]金真,林明欣,林燕玲,等.运用中医外治三联模式治疗0级糖尿病足40例临床观察[J].中华中医药杂志,2013,28(2):443-446.
[27]简小兵,王文英,戴莲仪,等.温阳养血活血通络法治疗0级糖尿病足的疗效观察[J].四川中医,2007,25(7):89-90.
[28]黄艳.中药泡足治疗糖尿病高危足的疗效观察及护理体会[J].广西中医药,2011,34(1):16-17.
[29]洪燕辉.中药泡足联合西药治疗护理糖尿病足[J].实用中医内科杂志,2013,27(6):125-126.
[30]管玉香,陈玉凤,汪莉.中药足部熏洗联合足底穴位按摩对0级糖尿病足的干预效应[J].中医药临床杂志,2011,23(12):1098-1099.
[31]丁福艳,张建波,王林娟,等.足浴结合中医护理对0级糖尿病足的疗效观察[J].中国中医药现代远程教育,2016,14(20):113-114.
[32]陈焱.中药熏洗治疗糖尿病足0级31例[J].中医研究,2007,20(2):40-41.
[33]陈青青.0级糖尿病足三虫桃红汤足浴联合足底反射区按摩的疗效观察[J].护理学报,2014,21(12):61-62.
[34]曾肃英.中药浴足配合艾灸足底穴位按摩对Wagner 0级糖尿病足疗效观察[J].糖尿病新世界,2014,34(9):25-26.
[35]曾庆伟.中药熏足对0级糖尿病足40例疗效观察[J].北方药学,2015,12(1):86,23.
[36]贾书冰,赵明沂,梁露花,等.漏斗图在meta分析中的正确使用研究[J].数理医药学杂志,2013,26(4):402-405.
[37]Guyatt GH,Oxman AD,Montori V,et al.GRADE指南:Ⅴ.证据质量评价--发表偏倚[J].中国循证医学杂志,2011,11(12):1430-1434.
[38]郭建平.中药足浴治疗糖尿病足85例临床观察[J].实用中医内科杂志,2006,20(1):74-75.
[39]Gordon G,Oxman AD,Akl E,et al.GRADE指南:Ⅰ.导论--GRADE证据概要表和结果总结表[J].中国循证医学杂志,2011,11(4):437-445.
[40]Balshem H,Helfanda M,Schunemann HJ,et al.GRADE指南:Ⅲ.证据质量分级[J].中国循证医学杂志,2011,11(4):451-455.