目的:评价半夏白术天麻汤治疗血管性头痛的临床疗效。方法:检索EMBASE、PUBMED、MEDLINE、AMED、CINAHL、Cochrane图书馆、中国知网数据库、重庆维普中文科技期刊数据库、中国生物医学文献数据库、万方数据库和中国中医药期刊文献数据库...目的:评价半夏白术天麻汤治疗血管性头痛的临床疗效。方法:检索EMBASE、PUBMED、MEDLINE、AMED、CINAHL、Cochrane图书馆、中国知网数据库、重庆维普中文科技期刊数据库、中国生物医学文献数据库、万方数据库和中国中医药期刊文献数据库,筛选从建库至2015年5月1日的半夏白术天麻汤治疗血管性头痛的随机对照试验研究。应用Cochrane评价员手册进行偏倚风险评价,Jadad评分法进行质量评价,应用Rev Man 5.3软件进行Meta分析。结果:符合纳入标准的文献共3篇。Meta分析结果:半夏白术天麻汤治疗血管性头痛治疗组与对照组比较,临床疗效总有效率比值比(odds ratio,OR)为6.25,95%可信区间(confidence interval,CI)为[2.28,17.16],差异有统计学意义(P=0.0004);显效率OR为4.81,95%CI为[2.51,9.22],差异有统计学意义(P<0.00001)。纳入研究未有不良反应报道。结论:半夏白术天麻汤治疗血管性头痛有较好临床疗效,但由于本系统评价纳入研究的样本总体质量较低,研究的数量和样本量均较小,尚需要更多高质量、多中心、大样本、严格设计的随机对照试验深入研究。展开更多
Context: Renal dysfunction is a complication of coronary artery bypass graft(CABG) surgery performed with cardiopulmonary bypass(CPB) that is associated with increased morbidity and mortality. N-acetylcysteine, an ant...Context: Renal dysfunction is a complication of coronary artery bypass graft(CABG) surgery performed with cardiopulmonary bypass(CPB) that is associated with increased morbidity and mortality. N-acetylcysteine, an antioxidant and vasodilator, counteracts renal ischemia and hypoxia. Objective: To determine whether perioperative intravenous(IV) N-acetylcysteine preserves renal function in high-risk patients undergoing CABG surgery with CPB compared with placebo. Design, Setting, and Patients: Randomized, quadruple blind, placebo-controlled trial(October 2003-September 2004) in operating rooms and general intensive care units(ICUs) of 2 Ontario tertiary care centers. The 295 patients required elective or urgent CABG and had at least 1 of the following: preexisting renal dysfunction, at least 70 years old, diabetes mellitus, impaired left ventricular function, or undergoing concomitant valve or redo surgery. Interventions: Patients received 4(2 intraoperative and 2 postoperative)doses of IV N-acetylcysteine(600 mg)(n=148) or placebo(n=147) over 24 hours. Main Outcome Measures: The primary outcome was the proportion of patients developing postoperative renal dysfunction, defined by an increase in serum creatinine level greater than 0.5 mg/dL(44 μmol/L) or a 25%increase from baseline within the first 5 postoperative days. Secondary outcomes included postoperative interventions and complications, the requirement for renal replacement therapy(RRT), adverse events, hospital mortality, and ICU and hospital length of stay. Results: There was no difference in the proportion of patients with postoperative renal dysfunction(29.7%vs 29.0%, P=.89; relative risk[RR], 1.03[95%confidence interval {CI}, 0.72-1.46]) in the N-acetylcysteine and placebo groups, respectively. We noted nonsignificant differences in postoperative interventions and complications, the need for RRT(0.7%vs 2.1%; P=.37), total(6.1%vs 9.6%; P=.26) and serious adverse events, hospital mortality(3.4%vs 2.7%; P >.99), and ICU and hospital length of stay between the N-acetylcysteine and placebo groups. A post hoc subgroup analysis of patients(baseline creatinine level >1.4 mg/dL[120 μmol/L]) showed a nonsignificant trend toward fewer patients experiencing postoperative renal dysfunction in the N-acetylcysteine group compared with the placebo group(25.0%vs 37.1%; P=.29). Conclusions: N-acety-lcysteine did not prevent postoperative renal dysfunction, interventions, complications, or mortality in high-risk patients undergoing CABG surgery with CPB. Further research is required to identify CABG patients at risk for postoperative renal events, valid markers of renal dysfunction, and to establish renal thresholds associated with important clinical outcomes.展开更多
文摘目的:评价半夏白术天麻汤治疗血管性头痛的临床疗效。方法:检索EMBASE、PUBMED、MEDLINE、AMED、CINAHL、Cochrane图书馆、中国知网数据库、重庆维普中文科技期刊数据库、中国生物医学文献数据库、万方数据库和中国中医药期刊文献数据库,筛选从建库至2015年5月1日的半夏白术天麻汤治疗血管性头痛的随机对照试验研究。应用Cochrane评价员手册进行偏倚风险评价,Jadad评分法进行质量评价,应用Rev Man 5.3软件进行Meta分析。结果:符合纳入标准的文献共3篇。Meta分析结果:半夏白术天麻汤治疗血管性头痛治疗组与对照组比较,临床疗效总有效率比值比(odds ratio,OR)为6.25,95%可信区间(confidence interval,CI)为[2.28,17.16],差异有统计学意义(P=0.0004);显效率OR为4.81,95%CI为[2.51,9.22],差异有统计学意义(P<0.00001)。纳入研究未有不良反应报道。结论:半夏白术天麻汤治疗血管性头痛有较好临床疗效,但由于本系统评价纳入研究的样本总体质量较低,研究的数量和样本量均较小,尚需要更多高质量、多中心、大样本、严格设计的随机对照试验深入研究。
文摘Context: Renal dysfunction is a complication of coronary artery bypass graft(CABG) surgery performed with cardiopulmonary bypass(CPB) that is associated with increased morbidity and mortality. N-acetylcysteine, an antioxidant and vasodilator, counteracts renal ischemia and hypoxia. Objective: To determine whether perioperative intravenous(IV) N-acetylcysteine preserves renal function in high-risk patients undergoing CABG surgery with CPB compared with placebo. Design, Setting, and Patients: Randomized, quadruple blind, placebo-controlled trial(October 2003-September 2004) in operating rooms and general intensive care units(ICUs) of 2 Ontario tertiary care centers. The 295 patients required elective or urgent CABG and had at least 1 of the following: preexisting renal dysfunction, at least 70 years old, diabetes mellitus, impaired left ventricular function, or undergoing concomitant valve or redo surgery. Interventions: Patients received 4(2 intraoperative and 2 postoperative)doses of IV N-acetylcysteine(600 mg)(n=148) or placebo(n=147) over 24 hours. Main Outcome Measures: The primary outcome was the proportion of patients developing postoperative renal dysfunction, defined by an increase in serum creatinine level greater than 0.5 mg/dL(44 μmol/L) or a 25%increase from baseline within the first 5 postoperative days. Secondary outcomes included postoperative interventions and complications, the requirement for renal replacement therapy(RRT), adverse events, hospital mortality, and ICU and hospital length of stay. Results: There was no difference in the proportion of patients with postoperative renal dysfunction(29.7%vs 29.0%, P=.89; relative risk[RR], 1.03[95%confidence interval {CI}, 0.72-1.46]) in the N-acetylcysteine and placebo groups, respectively. We noted nonsignificant differences in postoperative interventions and complications, the need for RRT(0.7%vs 2.1%; P=.37), total(6.1%vs 9.6%; P=.26) and serious adverse events, hospital mortality(3.4%vs 2.7%; P >.99), and ICU and hospital length of stay between the N-acetylcysteine and placebo groups. A post hoc subgroup analysis of patients(baseline creatinine level >1.4 mg/dL[120 μmol/L]) showed a nonsignificant trend toward fewer patients experiencing postoperative renal dysfunction in the N-acetylcysteine group compared with the placebo group(25.0%vs 37.1%; P=.29). Conclusions: N-acety-lcysteine did not prevent postoperative renal dysfunction, interventions, complications, or mortality in high-risk patients undergoing CABG surgery with CPB. Further research is required to identify CABG patients at risk for postoperative renal events, valid markers of renal dysfunction, and to establish renal thresholds associated with important clinical outcomes.
