中西医结合治疗重症肺炎临床随机对照试验的系统评价

System evaluation of randomized controlled trails of treating severe pneumonia with integrated traditional and western medicine

目的:评价中西医结合治疗重症肺炎的有效性和安全性。方法:检索CNKI、CBM、VIP、PubMed和Cochrane图书馆,纳入1998年5月-2008年6月公开发表在国内外医学期刊的中医药疗法或中西医结合疗法治疗重症肺炎的随机对照试验,手工检索发表与未发表的中文文献,2名评价人员独立提取资料。按Cochrane系统评价方法,对纳入研究逐个进行质量评价,而后采用RevMan 4.2.2软件对提取资料进行Meta分析。结果:3篇共涉及220名病人的随机临床试验符合纳入标准。均为低质量试验。临床疗效指标以总体有效率、症状、体征、白细胞、血气分析指标为主。中西医结合治疗重症肺炎有一定优势,表现在降低体温、减少呼吸次数、降低白细胞数、提高血氧饱和度和氧合指数、减少住院天数方面。试验未发现严重的不良反应。结论:由于纳入评价的文献方法学质量较低以及发表性偏倚的存在,中西医结合治疗重症肺炎的临床有效性和安全性有待于进一步验证。

Objective：To assess the curative effects and safety of integrated traditional and western medicine for severe pneumonia.Methods：Searches were applied to the following electronic databases：the CNKI,CBM,VIP,PubMed（1998～2008.6） and the Cochrane Library.No language restriction was used.Randomized controlled trials（RCTs） of clinical therapeutic studies on severe pneumonia by trditional Chinese medicine（TCM） were included.Data were extracted independently by two reviewers.All trials included were analyzed according to the criteria of the Cochrane Handbook.RevMan 4.2.2 software was used for data analysis.Results：Three RCTs（220 patients） with low methodological quality were included.The main therapeutic index includes total effective rate,symptoms,signs,white blood cell（WBC） and blood gas analysis.Integrated traditional and western medicine treatment group had some superiority,including reducing body temperature,decreasing respiration rate,decreasing elevated leukocyte number,improving blood oxygen saturation and oxygenation index.There was no severe adverse reaction in all trials.Conclusion：There was insufficent evidence for treating severe pneumonia with integrated traditional and western medicine due to the low quality trials.Further randomized,double blind,placebo-controlled trials were needed.