承气类方治疗脑卒中后意识障碍的系统评价与meta分析

Systematic evaluation and meta-analysis of Chengqi Decoction in the treatment of post-stroke consciousness disorder

目的评价承气类方治疗脑卒中后意识障碍的效果与安全性。方法计算机检索中国知网、万方、中国生物医学文献数据库、PubMed、Embase、Cochrane Library数据库,纳入承气类方治疗脑卒中后意识障碍的随机对照试验,检索时限从建库至2018年4月。由两位研究者独立筛选文献、提取资料和评价偏倚风险,采用RevMan 5.3软件进行meta分析。结果最终纳入10个随机对照试验,共775例患者。meta分析结果显示:试验组格拉斯哥昏迷评分高于对照组[MD=3.39,95%CI(3.05,3.73),P <0.000 01]。差异同样存在于各亚组分析中,急性缺血性脑卒中亚组[MD=3.17,95%CI(2.81,3.53),P <0.000 01]、急性出血性脑卒中亚组[MD=1.95,95%CI(0.94,2.97),P=0.0002]、口服亚组[MD=5.65,95%CI (3.84,7.46),P <0.000 01]、鼻饲亚组[MD=3.29,95%CI (3.16,3.42),P <0.000 01]、灌肠亚组[MD=1.80,95%CI(0.94,2.66),P <0.0001]、化痰通腑亚组[MD=5.65,95%CI(3.84,7.46),P <0.000 01]、通腑开窍亚组[MD=3.27,95%CI(3.10,3.44),P <0.000 01]格拉斯哥昏迷评分差异均有统计学意义。结论在常规治疗的基础上,联合承气类方可更好地改善脑卒中后意识障碍患者的意识水平,且安全性较好。

Objective To assess the effects and safety of Chengqi Decoction in the treatment of post-stroke consciousness disorder.Methods CNKI,Wanfang,China biomedical literature database,PubMed,Embase,Cochrane Library database were searched by computer.It was included in the randomized controlled trial of Chengqi Decoction in the treatment of post-stroke consciousness disorder,with the retrieval time from the establishment of the database to April2018.Two researchers independently selected literature,extracted data and evaluated the risk of bias,and RevMan 5.3 software was used to take meta-analysis.Results A total of 10 trails were enrolled,which included 775 cases.The meta-analysis showed that Glasgow coma score in experimental group was higher than that in control group(MD=3.39,95%CI[3.05,3.73],P<0.00001).Differences also existed in subgroup analysis,differences on Glasgow coma score of acute ischemic stroke sub group(MD=3.17,95%CI[2.81,3.53],P<0.00001),acute hemorrhagic stroke sub group(MD=1.95,95%CI[0.94,2.97],P=0.0002),oral sub group(MD=5.65,95%CI[3.84,7.46],P<0.00001),nasal feeding sub group(MD=3.29,95%CI[3.16,3.42],P<0.00001),enema sub group(MD=1.80,95%CI[0.94,2.66],P<0.0001),Huatan Tongfu sub group(MD=5.65,95%CI[3.84,7.46],P<0.00001),Tongfu Kaiqiao sub group(MD=3.27,95%CI[3.10,3.44],P<0.00001)were statistically significant.Conclusion On the basis of routine treatment,combined with Chengqi Decoction can better improve the level of consciousness of patients with post-stroke consciousness disorder,and the safety is better.