中医外治法用于辅助机械通气重症患者镇静镇痛疗效的Meta分析

Meta-analysis of the effect of traditional Chinese medicine external therapy on sedation and analgesia in severe patients with mechanical ventilation

目的采用Meta分析评价中医外治法联合西医常规治疗对机械通气重症患者镇静镇痛疗效的影响。方法应用计算机检索中国知网(CNKI)、万方数据库、中国生物医学文献服务系统(SinoMed)、维普、中国临床试验中心数据库、美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、Cochrane图书馆数据库以及美国临床试验中心关于中医外治法辅助机械通气治疗重症患者的随机对照试验(RCT)的文献,中文检索词为耳穴磁珠、耳穴、耳穴压豆、针刺、电针、经皮电穴位穿刺、重症监护病房(ICU)、镇静、镇痛、机械通气,英文检索词为auricular magnetic beads、acupuncture、auricular、respiration、artificial、mechanical ventilation、sedation、deep sedation、conscious sedation、analgesia、acupuncture analgesia、transcutaneous electric nerve stimulation、ICU,检索时间从建库至2021年1月29日。对照组干预措施为西医常规镇静镇痛治疗;试验组在对照组基础上加用中医外治法。由两名研究者独立筛选文献、提取资料并评价纳入文献的质量,以及进行偏倚风险评估后,采用RevMan 5.3软件进行Meta分析;绘制漏斗图分析纳入文献的发表偏倚。结果最终纳入18篇RCT,试验组534例,对照组524例。Meta分析结果显示,与对照组比较,试验组机械通气时间、ICU住院时间均明显缩短〔机械通气时间:均数差(MD)=-2.48,95%可信区间(95%CI)为-3.35~-1.60,P<0.00001;ICU住院时间:MD=-20.45,95%CI为-34.17~-6.74,P=0.003〕,咪达唑仑用量显著减少(MD=-5.73,95%CI为-8.39~-3.07,P<0.0001);而两组Ramsay镇静评分比较差异无统计学意义(MD=-0.05,95%CI为-0.03~0.13,P=0.24)。针对中医外治法联合西医常规治疗对重症患者机械通气时间的影响绘制漏斗图进行发表偏倚检验,结果显示,漏斗图左右分布对称,提示均不存在发表偏倚。结论中医外治法联合西医常规治疗可提高机械通气重症患者的疗效,但尚需更多高质量研究加以验证。

Objective To evaluate the efficacy of traditional Chinese medicine external therapy combined with conventional western medicine treatment on sedation and analgesia for treatment of severe mechanically ventilated patients by using Meta analysis.Methods A computer was used for retrieval;the published literatures in China National Knowledge Internet(CNKI),Databases of Wanfang,SinoMed,VIP,China Clinical Trial Center,PubMed,Embase,Cochrane Library and American Clinical Trial Center were searched for randomized controlled trials(RCT)on sedation and analgesia of severe patients with mechanical ventilation assisted by traditional Chinese medicine external therapy,from the establishment dates of the above journals and databases to January 29,2021.The Chinese search term were ear acupoint magnetic beads,ear acupoints,ear acupoint pressing beans,acupuncture,electro-acupuncture,transcutaneous electrical acupoint puncture,intensive care unit(ICU),sedation,analgesia,and mechanical ventilation;the English search term auricular magnetic beads,acupuncture,auricular,respiration,artificial,mechanical ventilation,sedation,deep sedation,conscious sedation,analgesia,acupuncture analgesia,transcutaneous electric nerve stimulation,ICU.The interfering measure was conventional western medicine sedation and analgesia treatment in the control group,while the measures in experimental group was on the basis of the western routine treatment in the control group,additionally traditional Chinese medicine external therapy was applied.Two researches independently screened the literatures,extracted data,evaluated the quality of enrolled literatures and carried out assessment of bias risks;after evaluation,Meta analysis was performed with RevMan 5.3 software;funnel graph was drawn to analyze the publishing bias of enrolled literatures.Results A total of 18 RCT were accepted,including 534 patients in the experimental group and 524 patients in the control group.Meta-analysis results showed that compared with the control group,the duration of mechanical ventilation and the ICU length of stay were significantly shortened[the duration of mechanical ventilation:mean difference(MD)=-2.48,95%confidence interval(95%CI)was-3.35 to-1.60,P<0.00001;the ICU length of stay:MD=-20.45,95%CI was-34.17 to-6.74,P=0.003],midazolam dosage was obviously decreased(MD=-5.73,95%CI was-8.39 to-3.07,P<0.0001).However,there was no significant difference in Ramsay sedation score between the two groups(MD=-0.05,95%CI was-0.03 to 0.13,P=0.24).A funnel plot was drawn to test the bias of the published literatures from directing at the effects of traditional Chinese medicine external therapy combined with conventional western medicine on mechanical ventilation time in critically ill patients;the results showed that the mechanical ventilation time was distributed symmetrically on the left and right sides of the funnel plot,suggesting that there was no publication bias.Conclusions Traditional Chinese medicine external therapy combined with conventional western medicine treatment can elevate the therapeutic effect of severe patients with mechanical ventilation,and the efficacy of combined method is significantly better than that of simple western medicine treatment.However,more high-quality studies are needed to test the above result.