氨溴索雾化吸入治疗肺炎的系统评价

Aerosol Inhalation of Ambroxol for Pneumonia:A Systematic Review

目的系统评价氨溴索雾化吸入治疗肺炎的疗效与安全性。方法电子检索MEDLINE、EMbase、Cochrane图书馆临床对照试验资料库、CBM和CNKI等数据库,收集氨溴索雾化吸入作为辅助治疗与空白或其他药物雾化吸入治疗肺炎的随机和半随机对照试验,对符合纳入标准的临床研究进行质量评价和Meta分析。结果共纳入13个研究,均为中文文献,所有研究均未描述具体的随机方法,均未说明是否实施了分配隐藏和采用了盲法及进行随访,Juni评分均为C级。Meta分析结果显示,与对照组比较,氨溴索雾化吸入在提高临床总有效率、改善症状体征以及缩短住院时间方面均显示出较好的疗效,虽少数研究/亚组无统计学差异,但均显示出有益趋势。未检索到评价氨溴索雾化吸入安全性方面的研究。结论由于氨溴索雾化吸入治疗肺炎的临床研究质量普遍较低,且缺乏安全性研究资料,因此对氨溴索雾化吸入治疗肺炎的有效性和安全性尚不能得出肯定的结论,有必要设计良好的随机双盲对照研究进行论证。

Objective To assess the effectiveness and safety of an aerosol inhalation of ambroxol in accessory treatment of pneumonia. Methods Biomedical databases, including MEDLINE, EMbase, The Cochrane Central Register of Controlled Trials （CENTRAL）, CBM-disk and CNKI were searched. Randomized controlled trials （RCTs） and quasi-RCTs that compare aerosol inhalation of ambroxol with placebo or other aerosol inhalation regimens were collected. A critical quality assessment and Meta-analysis were performed for included studies. Results Thirteen RCTs were included and all of them were carried out in China. None of the trials described the method of randomization, allocation concealment, blind, and follow-up. With Juni scales, 13 trials scored C degree. Compared with the control group, aerosol inhalation of ambroxol improved total improvement rate and symptoms, and shortened hospital stay. Although statistical difference was not found in some comparisons, all trials showed beneficial tendency. We didn＇t find any RCTs describing the safety of ambroxol aerosol inhalation. Conclusion Because of the low quality of RCTs on ambroxol aerosol inhalation for pneumonia, no reliable conclusion can be drawn from our Meta-analysis. Well-designed RCTs and economic evaluation are urgently needed to evaluate the value and safety of aerosol inhalation of ambroxol in treating pneumonia.