中医药治疗高血压伴失眠疗效的系统评价

Traditionnal Chinese Medicine in Treating Hypertension with InsomniaA Systematic Review of Randomized Controlled Trials

目的系统评价中医药治疗高血压伴失眠患者的临床疗效,为高血压伴失眠患者治疗提供参考意见。方法计算机检索中国知网(CNKI)、万方数据库(WanFang Data)、维普中文科技期刊数据库(VIP)、Pubmed数据库、Cochrane图书馆、医学文摘数据库(Embase),搜集中药结合基础降压治疗与西医镇静安眠药结合基础降压治疗的临床随机对照试验(randomized controlled trial,RCT),检索时间限定为各数据库建库至2020年6月,2名研究者根据纳入标准和排除标准筛选符合研究要求的文献,采用Cochrane偏倚风险评估工具评估纳入文献的方法学质量,并使用RevMan 5.3软件进行Meta分析。结果共纳入随机对照试验18项,包含患者1790例。Meta分析显示,试验组的治疗效果优于对照组,试验组匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表的总分、睡眠障碍量表(Sleep Dysfunction Rating Scale,SDRS)评分低于对照组,辅助降压效果优于对照组,治疗后失眠复发率较低,且不良反应发生少。结论中药治疗高血压伴失眠患者能够改善患者睡眠质量,降低患者血压水平。受纳入研究数量和质量限制,这一结论仍需高质量、大样本、多中心、随机双盲对照研究予以验证。

Objective To systematically evaluate the clinical efficacy of traditional Chinese medicine in the treatment of patients with hypertension and insomnia,and to provide reference opinions for the treatment of patients with hypertension and insomnia.Methods The randomized controlled trials(RCTs)was retrieved from CNKI,WanFang Data,VIP,PubMed,The Cochrane Library,EMbase from inception to June 2020.The RCTs of hypertension with sleep disorder treated by TCM were compared with that treated by sedative hypnotics.Two reviewers independently screened relevant studies according to predefined inclusion and exclusion criteria.The bias risks assessment tool provided by Cochrane collaborative network was used to evaluate the methodological quality of the included literatures and the meta-analysis was performed by using RevMan 5.3 software.Results A total of 18 randomized controlled trials were included,including 1790 patients.Meta-analysis showed that the total effective rate of the experimental group was higher than that of the control group.The total score of the Pittsburgh sleep quality index(PSQI)and the Sleep Dysfunction Rating Scale(SDRS)score of the experimental group were low.In the control group,the adjuvant antihypertensive effect is better than that of the control group,the recurrence rate of insomnia after treatment is lower,and the occurrence of adverse reactions is less.Conclusion TCM therapies can improve sleep quality and control blood pressure of therapy in hypertension with sleep disorder.Due to the limited quantity and quality of included studies,some multicenter randomized double-blind control studies with high quality and large sample are needed to verify the above conclusion.