清热凉血法治疗脑卒中后应激性溃疡的Meta分析

Meta-analysis of treating stress ulcer after stroke by Qingre Liangxue method

目的:对国内外已发表的有关中医清热凉血法治疗脑卒中后应激性溃疡的临床疗效及优势进行Meta分析。方法:计算机检索中国医学文献数据库、维普数据库、中国期刊全文数据库、万方数据库、PubMed、Cochrane Library数据库,检索时限为建库至2022年11月,由2名评价者独立筛选文献、提取资料和评价纳入研究偏倚后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入10项随机对照试验(RCT)文献,纳入病例总数1044例,其中观察组488例,对照组566例。Meta分析结果显示:与对照组比较,中医清热凉血法联合常规西医治疗脑卒中后应激性溃疡患者总有效率更高[OR=3.99,95%CI(2.40,6.63),P<0.001]、病死率更低[OR=0.43,95%CI(0.28,0.66),P<0.001]、止血时间更快、恢复清醒率更高[OR=2.59,95%CI(1.58,4.23),P<0.001]、恢复清醒时间更短、不良反应发生率更低[OR=0.19,95%CI(0.08,0.49),P<0.001]。在治疗后胃液pH值方面,观察组和对照组未见明显差异。结论:清热凉血法联合常规西医治疗可以提高治疗有效率、降低病死率、降低不良反应发生率、缩短止血时间、提高昏迷患者恢复清醒率及缩短恢复清醒时间。但纳入文献质量偏低,尚需更高质量RCT研究进行验证。

Objective To analyze the clinical efficacy and advantages of Qingre Liangxue method in the treatment of stress ulcer after stroke.Methods The Chinese medical literature database,VIP database,Chinese Journal Full-text Database,Wanfang database,PubMed and Cochrane Library database were searched by computer from database establishment to November 2022.Meta-analysis was performed using RevMan 5.3 software after two reviewers independently screened the literatures,extracted the data and evaluated the bias of the included studies.Results Ten randomized controlled trials were included,including 488 patients in the observation group and 566 patients in the control group.Meta-analysis showed that compared with the control group,the total effective rate of TCM cooling blood to stop bleeding combined with conventional western medicine in the treatment of post-stroke stress ulcer patients was higher[OR=3.99,95%CI(2.40,6.63),P<0.001],lower mortality[OR=0.43,95%CI(0.28,0.66),P<0.001],faster hemostasis time,higher recovery rate[OR=2.59,95%CI(1.58,4.23),P<0.001],shorter recovery time,lower incidence of adverse reactions[OR=0.19,95%CI(0.08,0.49),P<0.001].In terms of gastric pH after treatment,there were no significant differences between the observation group and the control group.Conclusion The method of clearing away heat and cooling blood combined with conventional western medicine can improve the effective rate,reduce the mortality,reduce the incidence of adverse reactions,shorten the time of hemostasis,improve the recovery rate of coma patients and shorten the recovery time of awake time.However,the quality of the included articles is low and higher quality RCTs are needed for validation.