基于循证医学的痔术后中药外用规律探讨

Medication Regularity of Chinese Herbal Medicine for Wound Healing after Hemorrhoidectomy: A Research Based on EBM

目的:基于循证医学,对痔术后中药外用规律进行探讨,以期为临床用药提供具有可靠循证医学证据的理论依据。方法:基于中药与高锰酸钾外用对痔术后伤口愈合疗效对比的系统评价及其GRADE证据质量,对纳入RCT用药进行药物使用频率、功效、性味、归经统计分析。结果:系统评价纳入RCT质量较差,GRADE证据质量均为极低。对最终纳入RCT中的28篇进行统计分析。发现共用药62种,用药269次,苦参、黄柏、五倍子、芒硝等用药频率较高;按药用功效共分为22类,以清热燥湿药使用最多;用药性味以苦、寒类药物最为常见;用药归经以归肝经最为常见。结论:本研究基于循证医学,通过对中药与高锰酸钾外用对痔术后伤口愈合疗效对比的系统评价中纳入RCT用药规律的分析,提示了清热燥湿法在治疗痔术后创面愈合过程中的主导地位。

Objective： To investigate the medication regularity of Chinese herbal medicine for wound healing after hemorrhoidectomy and to provide evidence- based theoretical basis for the clinical medication. Methods： Data based on the systematic reviews and Meta- analysis for efficacy and side effects of Chinese herbal medicine external treatment for wound healing after hemorrhoidectomy and the GRADE quality was extracted to analyze medication frequency,efficacy and properties（ including four natures of drugs,the five flavors and channel tropism）. Results： High quality studies were rare. GRADE quality of evidence： the quality of all the outcomes were very low. In 28 RCTs,62 Chinese medicines were used totally. The appearing frequency was 269. Kushen（ Radix Sophorae flavescentis）,Huangbai（ Cortex Phellodendri）,Wubeizi（ Rhus chinensis Mill） and Mangxiao（ Sodium Sulfate） were more commonly used than others. With regard to the herb efficacy,the use frequencies of heat- clearing and dampness- drying drugs were high. With regard to herb properties,the use frequencies of the cold drugs and the bitter drugs were higher. With regard to herb channel tropism,herbs with the liver meridian were the most commonly used. Conclusion： Medication regularity of Chinese herbal medicine for heat- clearing and dampness- drying method in hemorrhoids after hemorrhoidectomy was gained by analyzing medication frequency,efficacy and properties,which is based on EBM. All these findings need to be confirmed in further well designed comprehensive studies meeting the standard of evidence- based medicine.