宣白承气汤治疗成人急性呼吸窘迫综合征的Meta分析

Meta-analysis on Xuanbai Chengqi Decoction in Treating Acute Respiratory Distress Syndrome

目的评估宣白承气汤治疗成人急性呼吸窘迫综合征(ARDS)的临床疗效。方法计算机检索中文数据库(中国知网、万方、维普、CBM)和外文数据库(PubMed,Embase,Cochrane Library),查找宣白承气汤治疗成人ARDS的随机对照临床试验,根据纳入排除标准进行筛选,确定纳入的文献,进行数据提取。采用Cochrane的偏倚风险表评估研究质量,使用RevMan5.3进行统计分析。结果共纳入文献15篇,1042例患者。Meta分析结果显示,与单纯西医常规治疗相比,加用宣白承气汤治疗成人ARDS可降低患者死亡率(RR=0.57,95%CI[0.40,0.83],P=0.003)、呼气末正压(MD=-3.92,95%CI=[-4.16,-3.68],P<0.05)及缩短机械通气时间(MD=-78.84,95%CI=[-87.4,-70.27],P<0.05);同时可提高患者的临床治疗有效率(OR=3.06,95%CI[1.79,5.22],P<0.05)及氧合指数轻中度ARDS亚组(MD=26.94,95%CI=[23.7,30.19],P<0.05)、重度ARDS亚组(MD=19.07,95%CI=[16.92,21.21],P<0.05)。结论与单纯西医常规治疗相比,加用宣白承气汤在治疗成人ARDS方面可能具有较好的临床疗效。但文献质量有待提高,故需要高质量的随机对照试验来论证。

Objective:To evaluate the clinical efficacy of Xuanbai Chengqi Decoction in the treatment of adult acute respiratory distress(ADRS)syndrome.Methods:Chinese databases(CNKI,Wanfang,VIP,CBM)and foreign language databases(PubMed,Embase,Cochrane Library)were searched by computer for randomized controlled trials(RCTs)of Xuanbai Chengqi Decoction in the treatment of ARDS and screened according to inclusion and exclusion criteria to determine the included literature and perform data extraction.Cochrane’s risk of bias table was used to assess the quality of the study,and RevMan5.3 was used for statistical analysis.Results:A total of 15 RCTs were included,with 1042 patients.Meta-analysis results showed that compared with conventional western medicine treatment,combined Xuanbai Chengqi Decoction to the treatment of ARDS could reduce patient mortality[RR=0.57,95%CI(0.40,0.83),P=0.003],end-tidal positive pressure[MD=-3.92,95%CI(-4.16,-3.68),P<0.05]and shorten the time of mechanical ventilation[MD=-78.84,95%CI(-87.4,-70.27),P<0.05];at the same time,it could improve patients’effective rate of clinical treatment[OR=3.06,95%CI(1.79,5.22),P<0.05]and oxygenation index{subgroup of mild to moderate ARDS[MD=26.94,95%CI(23.7,30.19),P<0.05],severe ARDS subgroup[MD=19.07,95%CI(16.92,21.21),P<0.05]};Conclusion:Compared with conventional western medi?cine treatment alone,Xuanbai Chengqi Decoction may have a better clinical efficacy in the treatment of ARDS.However,the quality of the included literature needs to be improved,and high-quality RCTs are needed to further demonstrate the above conclusion.