中药熏药联合功能锻炼对促进动静脉内瘘成熟疗效的Meta分析

Meta-Analysis of Efficacy of TCM Fumigation Combined with Functional Exercise on Promoting Maturation of Arteriovenous Fistula

目的探讨中药熏药联合功能锻炼对促进血液透析患者自体动静脉内瘘成熟的疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普(VIP)、万方数据库,检索时间范围为建库至2021年3月。检索所有关于中药熏药对动静脉内瘘成熟疗效研究的随机对照试验,由2名文献研究员分别对检出文献进行筛选和评价,提取文献资料和有效数据,应用RevMan 5.4软件进行Meta分析。结果最终纳入文献9篇,共659例患者。分析结果显示,与对照组单纯功能锻炼相比,试验组能明显增加内瘘超声血流量[MD=55.62 mL·min^(-1),95%CI(33.86~77.38),P<0.00001]和透析血流量[MD=41.99 mL·min^(-1),95%CI(27.07~56.91),P<0.00001]、扩张头静脉内径[MD=0.95 mm,95%CI(0.05~1.84),P=0.04]、缩短内瘘成熟时间[MD=-9.32 d,95%CI(-12.22~-6.43),P<0.00001]以及提高首次穿刺成功率[RR=1.30,95%CI(1.14~1.49),P=0.0001]。结论中药熏药联合功能锻炼能有效缩短动静脉内瘘成熟时间,增加内瘘血流量,提高首次穿刺成功率,但在中药的选择、治疗频次、疗程以及安全性方面仍值得进一步探讨。

Objective To explore the effect of traditional Chinese medicine fumigation combined with functional exercise on promoting the maturation of autogenous arteriovenous fistula in hemodialysis patients.Methods We searched PubMed,Embase,Cochrane Library,Web of Science,CBM,CNKI,Weipu Database and Wanfang Database,and the retrieval period was from the establishment time until March 2021.All randomized controlled trials on the effects of traditional Chinese medicine fumigation on the maturation of arteriovenous fistula were searched.Two literature researchers were used to screen and evaluate the detected literature,and thenRevMan 5.4 software was used to analyze the data.Results There were 9 articles and 659 patients included.The analysis showed compared with the control group,the experimental group significantly increased the ultrasonic blood flow[MD=55.62 mL·min^(-1),95%CI(33.86~77.38),P<0.00001],dialysis blood flow[MD=41.99 mL·min^(-1),95%CI(27.07~56.91),P<0.00001],internal diameter of dilated cephalic vein[MD=0.95 mm,95%CI(0.05~1.84),P=0.04],shorten the maturation time of internal fistula[MD=-9.32 d,95%CI(-12.22~-6.43),P<0.00001]and increased first puncture success[RR=1.30,95%CI(1.14~1.49),P=0.0001].Conclusion Traditional Chinese medicine fumigation combined with functional exercise can effectively shorten the maturation time of arteriovenous fistula,increase the blood flow of internal fistula and improve the success rate of first puncture,but it is still worthy of further exploring in the selection,frequency,course of treatment and safety of traditional Chinese medicine.