中药预防第三磨牙拔除术后干槽症效果的Meta分析

Effects of Traditional Chinese Medicine(TCM) for Preventing Dry Socket Following Third Molar Extration:a Meta-analysis

目的:系统评价中药预防第三磨牙拔除术后干槽症的有效性和安全性。方法:计算机检索MEDLINE,Embase,CENTRAL,CBM,VIP,CNK I和WANFANG数据库中采用中药预防第三磨牙拔除术后干槽症的随机对照试验,同时手检纳入研究的参考文献,检索日期为建库至2011年4月31日。由2名评价者独立进行文献质量评价和资料提取后,采用RevM an5.1软件进行M eta分析。对不同干预措施采用亚组分析,采用漏斗图进行报告偏倚分析。结果:纳入17个研究共22个试验共计3 732个牙位。各研究间均具有同质性,故均采用固定效应模型。M eta分析结果显示:与空白对照及非中药组相比,中药组能显著降低干槽症的发生[RR=0.17,95%C I(0.12,0.24),P<0.00001]、减少术后出血[RR=0.28,95%C I(0.17,0.48),P<0.00001]、降低发生感染[RR=0.34,95%C I(0.14,0.81),P=0.01]、减轻术后疼痛[RR=0.16,95%C I(0.09,0.27),P<0.00001]、缓解术后肿胀[RR=0.68,95%C I(0.55,0.84),P=0.0004]、降低发生张口受限[RR=0.44,95%C I(0.26,0.74),P=0.002],且差异均具有统计学意义。因无不良反应的报道,故无法进行安全性评价。结论:采用中药预防的临床疗效是积极的,但局限性不可避免的影响了其论证强度,当前证据质量基于GRADE标准为"中级证据",建议临床推荐强度为"弱推荐"。故建议严格按照CONSORT标准设计高质量、大样本的随机对照盲法试验对其有效性进一步验证,并对其安全性进行评价。

Objective To evaluate the effectiveness and safety of TCM for preventing dry socket following the third teeth extraction.Methods We searched MEDLINE,Embase,CENTRAL,CBM,VIP,CNKI and WANFANG for randomized controlled trials up to April 31 in 2011,we also serached the revelant articles from the references of included studies.After study selection,data collection,assessment and analysis were undertaken by 2 reviewers independently,we performed meta-analysis by using the software RevMan 5.1 software.Subgroups analysis were used for different interventions while funnel plot for reporting bias.Results Collected 17 studies contained 22 trails of 3 732 third teeth were included.For there was no evidence of heterogeneity,all analysis used fixed effect model.The results of meta-analysis showed that:compared with blank and no-TCM groups,the TCM could obviously decrease the rate of dry socket[RR=0.17,95%CI(0.12,0.24),P<0.00001],reduce haemorrhage[RR=0.28,95%CI(0.17,0.48),P<0.00001],lower infection[RR=0.34,95%CI(0.14,0.81),P=0.01],lighten pain[RR=0.16,95%CI(0.09,0.27),P<0.00001],relieve swelling[RR=0.68,95%CI(0.55,0.84),P=0.0004],and lower restriction of mouth opening[RR=0.44,95%CI(0.26,0.74),P=0.002].Inducing there was no report of adverse reaction,the safety analysis could not be performed.Conclusion The clinical efficacy of TCM for prevention dry socket was positive.Due to the limitation of included RCTs,the quality of outcomes were 'moderate' based on GRADE,we suggest the clinicians should recommend it as 'Weak Recommendation'.And more high-quality,large-samples,randomized,double or triple blinding trials would be needed for further study,especially the adverse reactions should be observed and reported according to the CONSORT.