常规护理联合多种中医护理技术干预肝阳上亢型高血压合并失眠效果的网状Meta分析

Network Meta-analysis of routine nursing combined with multiple traditional Chinese medicine nursing technology in hypertension patients with hyperactivity of liver-Yang combined with insomnia

[目的]评价多种中医护理联合干预肝阳上亢型高血压合并失眠病人的睡眠质量和降压效果。[方法]计算机检索中国生物医学文献数据库(CBM)、万方数据库、中国学术期刊全文数据库(CNKI)、维普数据库(VIP)和外文数据库EMbase、the Cochrane Library、PubMed中有关中医护理干预肝阳上亢型高血压合并失眠症状的随机对照试验(RCT)。检索时间为各库建库时间至2019年4月21日,由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,使用RevMan 5.3软件进行风险偏倚图绘制,应用Stata 15.0和Gemtc 14.3软件进行网状Meta分析。[结果]共纳入7项RCTs,涉及649例病人。网状Meta分析结果显示,与单一常规护理比较,多种中医护理结合常规护理干预在匹兹堡睡眠质量指数(PSQI)评分方面,常规护理+耳穴压豆+中药足浴效果最好;在收缩压值方面,常规护理+穴位敷贴效果最好;在舒张压值方面,常规护理+耳穴压豆+穴位按摩+中药足浴效果最好。[结论]现有证据表明多种中医护理联合干预肝阳上亢型高血压合并失眠病人的睡眠质量和降压效果优于单一常规护理,其中常规护理+耳穴压豆+穴位按摩+中药足浴可能是最优选择。

Objective:To evaluate the quality of sleep and the effect of reducing blood pressure in patients with hyperactivity of liver-Yang hypertension combined with insomnia.Methods:Randomized controlled trials on traditional Chinese medicine nursing intervention on hypertension complicated with insomnia in the type of hyperactivity liver-Yang were retrieved from CBM,WanFang database,CNKI,VIP,EMbase,the Cochrane Library and PubMed.The retrieval time was from databases establishment to 21 April,2019.Screening of literatures,extraction of data,evaluation of bias risk of included studies were implentment by two reviewers independently.RevMan 5.3 software was used for draw the risk bias map,and Stata 15.0 and Gemtc 14.3 software were used for network Meta-analysis.Results:A total of 7 articles were included,involving 649 patients.The results of network Meta-analysis showed that,routine nursing+auricular point bean pressing+traditional Chinese medicine foot bath had the best effect in Pittsburgh Sleep Quality Index(PSQI)score compared with single routine nursing,and routine nursing+acupoint application had the best effect in terms of systolic pressure.In terms of diastolic blood pressure,the effect of routine nursing+auricular point bean pressing+acupoint massage+traditional Chinese medicine foot bath is the best.Conclusion:The current evidences shows that the sleep quality and antihypertensive effect of many kinds of traditional Chinese medicine nursing combined with liver-Yang hyperactivity hypertension complicated with insomnia are better than those of single routine nursing,among which routine nursing+auricular point bean pressing+acupoint massage+foot bath of traditional Chinese medicine maybe the best choice.