盐酸氨溴索不同给药方式治疗呼吸道疾病系统评价和Meta分析

Systematic Review and Meta-Analysis of Different Administration Modes of Ambroxol Hydrochloride in the Treatment of Respiratory Diseases

目的:系统性评价盐酸氨溴索的雾化吸入和静脉滴注两种不同给药方式(以下简称为雾化给药和滴注给药)对于治疗不同呼吸道系统疾病的效果。方法:系统检索PubMed、Web of Science、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)和万方数据库,搜索国内外有关盐酸氨溴索采取不同给药方式治疗呼吸道疾病所有公开发表的相关文章并评价相关纳入文献的质量。使用Stata16.0和14.0数据统计软件进行Meta分析。结果:共纳入15篇相关研究,共收入实验参与者1366例,其中采取静脉滴注给药683例,雾化吸入给药683例。根据当前国内研究证据,对于呼吸道感染的辅助治疗,盐酸氨溴索雾化吸入和静脉滴注对于不同种类疾病有着不同效果,Meta最终结果显示,雾化给药相比滴注给药能更加有效的治疗相关呼吸系统感染,log OR=0.87,95%CI(0.28,1.46)。在亚组分析中显示,对于慢性支气管炎雾化给药相比滴注给药更能治愈疾病,log OR=1.76,95%CI(0.92,2.1)。滴注给药和雾化给药对于肺部炎症的治疗效果两者无明显差异,log OR=0.02,95%CI(-0.87,0.91)。Meta分析结果显示,相比滴注给药,盐酸氨溴索雾化给药能更好的治愈儿科呼吸道疾病,log OR=1.12,95%CI(0.67,1.97)。关于二者的不良反应,Meta统计结果表明:盐酸氨溴索治疗不同疾病采取不同给药方式中,滴注给药更能引起相关不良反应,例如恶心,过敏等,雾化给药的不良反应情况更小,log OR=-1.38,95%CI(-2.221,-0.54)P=0.00。结论:在临床治疗过程中,相比常规的滴注给药的方式,采取雾化形式给药的盐酸氨溴索更具优势,有望成为治疗呼吸系统疾病的优先选择。在临床治疗过程中,建议考虑疾病的种类给与药物,且从临床应用过程中的疗效和安全性考虑,建议选择盐酸氨溴索采取雾化吸入方式给药。

Objective:To systematically evaluate two different drug delivery methods of nebulized inhalation and intravenous drip administration of amiloride hydrochloride(hereinafter referred to as nebulized administration and drip administration)for the treatment of different respiratory system diseases.Methods:PubMed,Web of Science,China Journal Full Text Database(CNKI),Chinese Science and Technology Journal Full Text Database(VIP)and Wanfang Database were systematically searched for all published articles on different administration modes of Ambroxol hydrochloride for the treatment of respiratory diseases at home and abroad,and the quality of relevant included literature was evaluated.Meta-analysis was performed using Stata 16.0 and 14.0 data statistical software.Results:A total of 15 relevant studies were included.A total of 1366 experimental participants were included,of which 683 were administered by intravenous drip and 683 by nebulized inhalation.According to the current domestic research evidence,nebulized inhalation and intravenous drip administration of amiloride hydrochloride have different effects on the adjuvant treatment of respiratory tract infections,and the final results of Meta showed that nebulized administration was more effective than drip administration in the treatment of related respiratory infections,with a log OR=0.87,95%CI(0.28,1.46).In a subgroup analysis,nebulized administration was more effective in curing chronic bronchitis compared to drip administration,with an log OR=1.76,95%CI(0.92,2.1).Meta-analysis showed that nebulized administration of Ambroxol hydrochloride was more effective in treating pediatric respiratory disease than drip administration,log OR=1.12,95%CI(0.67,1.97).Meta-statistics on the adverse effects of both showed that among the different modes of administration of Ambroxol hydrochloride for different diseases,drip administration was more likely to cause adverse effects such as nausea and allergy,while nebulized administration was less likely to cause adverse effects.The log OR=-1.38,95%CI(-2.221,-0.54)P=0.00.Conclusion:In clinical treatment,the therapeutic effect of nebulized administration of amiloride hydrochloride is more advantageous than that of conventional drip administration.It is expected to be the preferred choice for the treatment of respiratory diseases.In the clinical treatment process,it is recommended to consider the type of disease to give the drug,and from the consideration of the efficacy and safety in the process of drug use,it is recommended to choose the nebulized inhalation mode of administration of Ambroxol hydrochloride.