化痰通腑法治疗缺血性中风急性期的Meta分析

Efficacy of treatment on acute ischemic stroke by phlegm removing to relax bowels:A Meta analysis

目的:评价化痰通腑法治疗缺血性中风急性期的疗效。方法:计算机检索the Cochrane Central Register of Controlled Trials、PubMed、Embase、CBMdisc、VIP、CNKI和WANFANG数据库,检索并纳入以化痰通腑法为主要组方依据的临床随机对照试验(RCT),检索年限自1989年1月至2013年12月。采用Cochrane协作网RevMan 5.2软件进行分析,文献质量评价采用修改后的Jadad量表。提取资料采用χ2检验鉴定研究间异质性,根据检验结果选用固定效应模型或随机效应模型,分别按临床疗效评定标准判定的病情改变情况、治疗前后神经功能缺损程度评分(NIHSS)、ADL-Barthel指数积分进行亚组分析。结果:纳入8个随机对照实验,共1 037例受试者,文献质量普遍较低。6个研究评价涉及临床疗效评定标准,5个研究评价涉及NIHSS评分,4个研究评价涉及ADL-Barthel指数积分;Meta分析显示与常规西药治疗相比,加用中药干预对缺血性中风急性期患者病情改变情况的影响具有统计学差异[RR=5.21,95%CI(3.53,7.68),P<0.00001];对NIHSS评分的影响具有统计学差异[MD=-7.44,95%CI(-8.68,-6.19),P<0.00001];对ADL-Barthel指数积分的影响具有统计学差异[MD=17.58,95%CI(14.49,20.68),P<0.00001]。结论:在常规治疗基础上加用中药化痰通腑法治疗缺血性中风急性期,可以改善神经功能缺损,提高临床疗效。

Objective： To systematically assess the efficacy of phlegm removing to relax bowels treatment on acute ischemic stroke. Methods： Randomized controlled trials （RCTs） of treatment on acute ischemic stroke by removing phlegm to relax bowels from January 1989 to December 2013 were retrieved from the database of Cochrane Central Register of Controlled Trials, PubMed, Embase, CBMdisc, VIP, CNKI and WANFANG, the outcomes of which were assessed systematically by meta-analysis. With RevMan5.2, the quality of studies were assessed by modified Jadad scale. Besides, data was extracted by chi-square test to identify the heterogeneity between research and selected fixed effects model or random effects model on the base of test results and analyzed subgroups of the situation of change of patient condition based on clinical efficacy assessment criteria, before and after score of NIHSS and ADL-Barthel index points. Results： 8 studies with 1 037 participants were included but the quality of which was low. 6 studies included the evaluation of clinical efficacy assessment criteria. 5 studies included the evaluation of NIHSS. 4 studies included the evaluation of ADL-Barthel index points. The results showed that compared with mere basic modem medicine treatment it could significantly improve clinical efficacy [RR=5.21, 95%CI（3.53,7.68）, P〈0.00001], reduce the score of NIHSS [MD=-7.44, 95%CI（-8.68,-6.19）, P〈0.00001] and improve the score of ADL-Barthel index points [MD=17.58, 95%CI（14.49, 20.68）, P〈0.00001]. Conclusion： Treatment of acute ischemic stroke by removing phlegm to relax bowels on the base of modem medicine take advantages on reducing symptom severity of cerebral ischemic stroke and promoting clinical efficacy.