口服或鼻饲中成药治疗高血压性脑出血的网状Meta分析

Network Meta-analysis of oral or nasal feeding with Chinese patent medicine in treatment of hypertensive intracerebral hemorrhage

运用网状Meta分析的方法系统评价口服或鼻饲中成药治疗高血压性脑出血的效果。计算机检索四大中文数据库(CNKI、VIP、Wanfang、CBM)、三大英文数据库(Medline、EMbase、Cochrane Library)及ClinicalTrials.gov,检索时间为各数据库建库至2020年10月29日,按照设定的纳入和排除标准筛选口服或鼻饲中成药联合西医常规治疗高血压性脑出血的随机对照试验(randomized controlled trial,RCT)。采用“Cochrane偏倚风险评估”工具对所纳入的研究进行质量评价,应用Stata 16.0软件对结局指标进行数据分析。共检索出3888篇文献,最终纳入30项研究,涉及6种中成药。总样本量2758例,其中试验组1401例,对照组1357例。网状Meta分析结果显示,(1)改善神经功能缺损程度方面,中成药疗效排序依次为西医常规治疗联合消瘀康胶囊>联合通心络胶囊>联合脑血康口服液>联合脑血疏口服液>联合安宫牛黄丸>西医常规治疗;(2)减少残余脑血肿量方面,中成药疗效排序依次为西医常规治疗联合脑血疏口服液>联合消瘀康胶囊>联合脑血康口服液>西医常规治疗;(3)改善日常生活能力方面,中成药疗效排序依次为西医常规治疗联合参蛭活血胶囊>联合安宫牛黄丸>联合脑血疏口服液>西医常规治疗;(4)改善总有效率方面,中成药疗效排序依次为西医常规治疗联合脑血疏口服液>联合消瘀康胶囊>联合安宫牛黄丸=联合脑血康口服液>联合通心络胶囊>西医常规治疗。结果表明,在西医常规治疗基础上,联合使用中成药可提高高血压性脑出血的临床治疗效果。但由于不同中成药纳入的研究数量及质量间存在差异,且缺乏中成药直接比较的研究,故其排序结果仍有待开展多中心、大样本的随机双盲试验加以论证,为临床用药提供更加可靠的证据支持。

The effect of oral or nasal feeding with Chinese patent medicine on hypertensive intracerebral hemorrhage was systematically evaluated by using the method of network Meta-analysis.Four Chinese databases(CNKI,VIP,Wanfang,CBM),three English databases(Medline,EMbase,Cochrane Library)and ClinicalTrials.gov were retrieved through computers.According to the inclusion criteria and exclusion criteria,randomized controlled trials(RCTs)of Chinese patent medicine combined with Western medicine in the treatment of hypertensive intracerebral hemorrhage were screened out according to the inclusion criteria and exclusion criteria.The Cochrane bias risk assessment tool was used to evaluate the quality of the included studies,and Stata 16.0 software was used to analyze the outcome indicators.A total of 3888 literatures were retrieved,and 30 studies involving 6 kinds of Chinese patent medicines were finally included.The total sample size was 2758 cases,including 1401 cases in the treatment group and 1357 cases in the control group.According to the results of network Meta-analysis,(1)in terms of improving the degree of nerve function defect,the order of Chinese patent medicines was conventional Western medicine combined with Xiaoyukang Capsules>combined with Tongxinluo Capsules>combined with Naoxuekang Oral Liquid>combined with Naoxueshu Oral Liquid>combined with Angong Niuhuang Pills>conventional Western medicine;(2)in terms of reducing the amount of residual cerebral hematoma,the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid>combined Xiaoyukang Capsules>combined Naoxuekang Oral Liquid>conventional Western medicine;(3)in terms of improving ability of daily living,the order of Chinese patent medicines was conventional Western medicine combined with Shenzhi Huoxue Capsules>combined with Angong Niuhuang Pills>combined with Naoxueshu Oral Liquid>conventional Western medicine;(4)in terms of improving total effective rate,the order of Chinese patent medicines was conventional Western medicine combined with Naoxueshu Oral Liquid>combined with Xiaoyukang Capsules>combined with Angong Niuhuang Pills=combined with Naoxuekang Oral Liquid>combined Tongxinluo Capsules>conventional Western medicine treatment.The results showed that in addition to conventional Western medicine therapy,the combined use with Chinese patent medicine can improve the clinical efficacy in the treatment of hypertensive intracerebral hemorrhage.However,due to the differences in the number and quality of various Chinese patent medicines included in the studies,and the lack of direct comparison of Chinese patent medicines,the ranking results still need to be verified by multi center,large-sample-size randomized double-blind trials in the future,so as to provide more reliable evidence support for clinical drug use.