中药注射剂治疗呼吸机相关性肺炎疗效的网络Meta分析

A network Meta-analysis on efficacy of traditional Chinese medicine injections in treatment of ventilator-associated pneumonia

目的采用网络Meta分析方法评价中药注射剂治疗呼吸机相关性肺炎的效果,为呼吸机相关性肺炎的临床治疗提供依据。方法基于万方数据库、中国知网(CNKI)、维普、ScienceDirect、Medline、PubMed、考克兰图书馆等数据库,检索建库至2020年7月1日的中药注射剂治疗呼吸机相关性肺炎的临床随机对照试验文献,根据预先确定的纳入和排除标准对文献进行筛选,采用Stata 15.0软件对数据进行分析。结果共纳入11项中文随机对照试验,包括766例患者涉及4种中药注射剂(参麦注射液、痰热清、血必净和醒脑静)。网络Meta分析结果显示,相对于单纯常规治疗,联用血必净(RR=1.54,95%CI[1.18,2.00],P=0.00)、痰热清(RR=1.26,95%CI[1.12,1.42],P=0.00)能显著提高临床有效率;联用参麦注射液(WMD=-3.10,95%CI[-4.87,-1.33],P=0.00)和痰热清(WMD=-3.04,95%CI[-3.75,-2.32],P=0.00)均能显著缩短机械通气时间。排序分析结果显示,联用痰热清治疗后在机械通气时间、降钙素原(procalcitonin,PCT)和临床肺部感染评分(clinical pulmonary infection score,CPIS)3个评价指标中排序均为最优,其有效率排序仅次于联用血必净,但是二者之间无统计学差异。结论联合使用参麦注射液、血必净、痰热清等中药注射剂治疗呼吸机相关性肺炎,疗效优于单纯常规治疗,其中可优先选择痰热清。

Objective To systematically evaluate the efficacy of traditional Chinese medicine injection in treatment of ventilator-associated pneumonia(VAP)by network Meta-analysis,and provide evidence for the optimization of clinical therapy on VAP.Methods The randomized controlled trials(RCTs)of traditional Chinese medicine injections in the treatment of VAP were searched from WanFang Data,CNKI,VIP Database,ScienceDirect,Medline,PubMed,and the Cochrane Library from the time of database establishment to July 1 st,2020.The RCTs were screened according to the inclusion and exclusion criteria,and the data were analyzed by Stata 15.0 software.Results A total of 766 patients were included in 11 RCTs,and there were four kinds of traditional Chinese medicine injections including Shenmai Injection,Tanreqing Injection,Xuebijing Injection,and Xingnaojing Injection involved.Network meta-analysis results showed that compared with routine therapy(RT)alone,the treatment in combination with Xuebijing Injection or Tanreqing Injection significantly improved the effective rate(For Xuebijing Injection+RT,RR=1.54,95%CI[1.18,2.00],P=0.00;For Tanreqing+RT,RR=1.26,95%CI[1.12,1.42],P=0.00),while combining with Shenmai Injection or Tanreqing Injection significantly reduced the duration of mechanical ventilation(For Shenmai Injection+RT,WMD=-3.10,95%CI[-4.87,-1.33],P=0.00;For Tanreqing Injection+RT,WMD=-3.04,95%CI[-3.75,-2.32],P=0.00).Probability ranking results showed that in terms of three therapeutic indicators including duration of mechanical ventilation,procalcitonin(PCT),and clinical pulmonary infection score(CPIS),Tanreqing Injection combined with routine therapy was the best choice for the treatment on VAP.Although the effective rate of Tanreqing Injection combined with routine therapy was lower than that of Xuebijing Injection,no significant difference was observed between them.Conclusion The results demonstrated that Shenmai Injection,Xuebijing Injection or Tanreqing Injection combined with routine therapy were more effective than that of the routine therapy alone on the treatment of VAP,and among three injections,Tanreqing Injection is the best choice.