中西医结合治疗重症肺炎疗效及安全性的Meta分析
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摘要
目的:评价中西医结合治疗重症肺炎的疗效及安全性。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741篇文献,最终纳入17个研究,总样本数为1261例,试验组642例和对照组619例。结果:中西医结合治疗重症肺炎与单用西医治疗相比,能有效降低病死率[RR=0. 45,95%CI(0. 30,0. 68),P=0. 00001];提高总有效率[RR=1. 21,95%CI(1. 11,1. 32),P <0. 00001]、减少住院天数[MD=-2. 7,95%CI(-4. 18,-1. 21),P=0. 0003];缩短机械通气时间[SMD=-1. 33,95%CI(-2. 43,-0. 22),P≤0. 00001]。不良反应较轻微,主要以胃肠道反应和头疼为主。结论:中西医结合治疗重症肺炎,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以验证。
Objective: The paper is to systematically evaluate the effect and safety of integrated traditional and western medicine for severe pneumonia. Methods: Randomized controlled trials( RCTs) were electronically retrieved from CNKI,Wanfang Data,VIP,Sino Med,EMbase,Pubmed and Cochrane Library 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 Rev Man 5. 3 software for Meta-analysis. A total of 741 articles were retrieved,and finally 17 studies were included. The total sample number was 1261,including 642 cases in experimental group and 619 cases in control group. Results: Compared with conventional medicine,integrated traditional and western medicine reduced the mortality[RR = 0. 45,95% CI( 0. 30,0. 68),P = 0. 00001],had better efficiency[RR = 1. 21,95% CI( 1. 11,1. 32),P < 0. 00001],reduced duration of hospital stay[MD =-2. 7,95% CI(-4. 18,-1. 21),P = 0. 0003] and duration of mechanical ventilation [SMD =-1. 33,95% CI(-2. 43,-0. 22),P ≤0.00001]. The main adverse reactions reported were gastrointestinal symptoms and headache. Conclusion: Integrated traditional and western medicine showed better efficacy than conventional medicine in treatment of severe pneumonia. However,because of low-quality in the included studies,more high-quality randomized controlled trials would be needed in the future.
Objective: The paper is to systematically evaluate the effect and safety of integrated traditional and western medicine for severe pneumonia. Methods: Randomized controlled trials( RCTs) were electronically retrieved from CNKI,Wanfang Data,VIP,Sino Med,EMbase,Pubmed and Cochrane Library 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 Rev Man 5. 3 software for Meta-analysis. A total of 741 articles were retrieved,and finally 17 studies were included. The total sample number was 1261,including 642 cases in experimental group and 619 cases in control group. Results: Compared with conventional medicine,integrated traditional and western medicine reduced the mortality[RR = 0. 45,95% CI( 0. 30,0. 68),P = 0. 00001],had better efficiency[RR = 1. 21,95% CI( 1. 11,1. 32),P < 0. 00001],reduced duration of hospital stay[MD =-2. 7,95% CI(-4. 18,-1. 21),P = 0. 0003] and duration of mechanical ventilation [SMD =-1. 33,95% CI(-2. 43,-0. 22),P ≤0.00001]. The main adverse reactions reported were gastrointestinal symptoms and headache. Conclusion: Integrated traditional and western medicine showed better efficacy than conventional medicine in treatment of severe pneumonia. However,because of low-quality in the included studies,more high-quality randomized controlled trials would be needed in the future.
引文
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[2]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):1-27.
[3]T Welte,A Torres,D Nathwani.Clinical and economic burden of community-acquired pneumonia among adults in Europe[J].Thorax,2012,67(1):71-79.
[4]American Thoracic Society.Guidelines for the management of adults with community acquired pneumonia[J].Am J Crit Care Med,2001,163(7):1730-1754.
[5]Restrepo MI,Mortensen EM,Velez JA,et al.A comparative study of community-acquired pneumonia patients admitted to the ward and the ICU[J].Chest,2008,133(3):610-617.
[6]Sang-Ho Choi,Sang-Bum Hong,Gwang-Beom Ko,et al.Viral infection in patients with severe pneumonia requiring intensive care unit admission[J].Am J Respir Crit Care Med,2012,186(4):325-332.
[7]Menendez R,Torres A,Zalacain R,et al.Risk factors of treatment failure in community acquired pneumonia:implications for disease outcome[J].Thorax,2004,59(11):960-965.
[8]韩芳,张丽,赵珊.血必净注射液对重症肺炎患者免疫功能的影响[J].中国医学工程,2012,20(01):33-34.
[9]王海峰,李建生,王至婉,等.中西医结合治疗重症肺炎临床随机对照试验的系统评价[J].中华中医药杂志,2010,25(5):738-742.
[10]Christophe Martil,Nicolas Garinl,Olivier Grosgurin,et al.Prediction of severe community-acquired pneumonia:a systematic review and meta-analysis[J].Critical Care,2012,16:R141.
[11]Mandell LA,Wunderink RG,Anzueto A,et al.Infectious Disease Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J].Clin Infect Dis,2007,44(Suppl 2):S27-72.
[12]韩健.白虎汤联合还原型谷胱甘肽治疗重症肺炎伴高热临床研究[J].中医学报,2017,32(2):201-205.
[13]徐国亮.麻杏石甘汤合千金苇茎汤加味治疗重症肺炎疗效观察[J].中国中医急症,2016,25(9):1805-1806.
[14]何丰华,刘毓姿,吴晔,等.麻杏石甘汤治疗痰热壅肺型重症肺炎的临床研究[J].国际中医中药杂志,2015,37(3):220-223.
[15]沈贵洪,吕益,胡玲玲.清肺保元汤联合西药治疗重症肺炎临床观察[J].中国中医急症,2015,24(1):177-178.
[16]谌洪俊,欧江琴,刘良丽.清肺保元汤联合西医治疗对重症肺炎患者血清IL-2,IL-6,IFN-γ的影响[J].中华中医药杂志,2012,27(11):3000-3003.
[17]刘德智,周霞,高尚兰.清肺承气汤辅助治疗重症肺炎痰热壅肺证临床分析[J].中国实验方剂学杂志,2016,22(8):191-195.
[18]钟云,阮晓东.清肺涤痰法治疗痰热壅肺型重症肺炎临床观察[J].中国中医急症,2015,24(9):1668-1669.
[19]岳煜,李欣,卢巧喜.清肺逐瘀汤佐治重症肺炎的疗效及对血清降钙素原的影响[J].中国临床研究,2016,29(9):1269-1270.
[20]于大兴.清化方对重症肺炎患者病情相关指标的影响及其炎症机制的探索[D].北京:中国中医科学院,2016.
[21]史肃育,吴同启,王克俭,等.通腑法治疗重症肺炎(实热证)的临床观察[J].中国中医急症,2014,23(6):1125-1127.
[22]周丹丹.宣白承气汤对痰热壅肺型重症肺炎患者的临床研究[D].广州:广州中医药大学,2013.
[23]吕雪莹,王修平,石一杰,等.益气化痰法对重症肺炎患者血清s TREM-1水平变化的研究[J].中国实用医药,2017,12(12):1-4.
[24]钭南霖,张剑,邓俊义,等.中西医结合治疗重症肺炎患者临床疗效观察及对患者炎症因子水平的影响[J].中国中医急症,2016,25(2):363-365.
[25]何梅雅.中西医结合治疗重症肺炎临床疗效观察及其安全性评价[J].中华中医药学刊,2015,33(7):1756-1758.
[26]奚肇庆,郑玥.中西医结合治疗重症肺炎痰热壅肺气阴两损证40例临床研究[J].江苏中医药,2016,48(3):29-31.
[27]黄婧文,李冬玲.自拟宣壅清肺汤辅助西医治疗重症肺炎(痰热壅肺证)临床观察[J].中国中医急症,2017,26(1):155-157.
[28]杨吉荣.中药联合抗生素治疗急性重症肺炎66例临床观察[J].中国中医急症,2012,21(6):970-970.