基于网状Meta分析的中西医结合治疗五步蛇咬伤的效果评价

Effectiveness Evaluation of Integrated Chinese and Western Medicine Therapy for Snakebite of Deinagkistrodon acutus:A Network Meta-analysis

【目的】基于网状Meta分析评价中西医结合治疗方案在五步蛇咬伤方面的有效性。【方法】计算机检索中国期刊全文数据库、万方数据库、PubMed、Embase数据库中有关常规西医治疗(对照组)对比中西医结合(观察组)治疗五步蛇咬伤的临床对照试验,采用改良的Jadad量表进行文献质量评价,采用ADDIS软件对数据进行网状Meta分析。【结果】共纳入15个RCTs。观察组与对照组的有效性的分析结果显示:观察组的有效率及其在改善肿胀消退时间、疼痛消退时间方面优于对照组,差异均有统计学意义(P<0.05)。不同中医疗法的网状Meta分析结果显示:蛇伤一号合剂联合常规西医治疗的近期疗效有效率优于单纯常规西医治疗;三七皂苷联合常规西医治疗在改善肿胀消退时间方面优于单纯常规西医治疗;莲花解毒汤联合常规西医治疗在改善疼痛消退时间方面优于单纯常规西医治疗,差异均有统计学意义(P<0.05)。【结论】分析结果支持中西医结合治疗五步蛇咬伤优于常规西医治疗方案。但由于纳入文献的质量较低,其结论有待后续研究扩大样本量,延长随访时间,开展多中心随机对照试验,以进一步提高研究结果的真实性和准确性。

Objective To investigate the efficacy of integrated Chinese and western medicine therapy for snakebite of Deinagkistrodon acutus with the network meta-analysis.Methods The clinical control trials of conventional western medicine(control group)versus integrated Chinese and western medicine(observation group)for the treatment of snakebite of Deinagkistrodon acutus were retrieved from the databases of CNKI,Wangfang Data,PubMed,and Embase.The modified Jadad scale was used for the evaluation of the literature quality,and ADDIS software was used for network meta-analysis.Results A total of 15 trials were included.The analysis of effectiveness between the observation group and the control group showed that the effective rate,time for subsiding swelling,and time for pain relief in the observation group were superior to those in the control group,and the differences were statistically significant(P<0.05).The results of network meta-analysis of various traditional Chinese medicine therapies showed that the short-term effective rate of Sheshang No.1 Mixture combined with conventional western medicine was superior to that of conventional western medicine alone,the improvement of time for subsiding swelling by notoginsenoside combined with conventional western medicine was superior to that by conventional western medicine alone,and the improvement of time for pain relief by Lianhua Jiedu Decoction combined with conventional western medicine was superior to that by conventional western medicine alone,the differences all being statistically significant(P<0.05).Conclusion The current evidence supports that integrated Chinese and western medicine therapy for snakebite of Deinagkistrodon acutus is superior to conventional western medicine alone.However,for the low quality of the included studies,the conclusion is still needed to be verified by the multi-center randomized control trials with larger sample size and longer follow-up time,so as to enhance the authenticity and accuracy of the studies.