A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

Exercise-based rehabilitation programmes for pulmonary hypertension:a systematic review and meta-analysis of randomized controlled trails

Objective Individuals with pulmonary hypertension(PH)have reduced exercise capacity and quality of life.Exercise-based rehabilitation may have beneficial effects to improve the exercise capacity and quality of life in patients with PH.We aim to assess the efficacy and safety of exercised-based rehabilitation for people eith PH by performing a randomized controlled trails(RCTs)meta-analysis of exercised-based rehabilitation for people with PH by performing a randomized controlled trails meta-analysis.

Efficacy of intraorbital electroacupuncture for diabetic abducens nerve palsy： study protocol for a prospective single-center randomized controlled trial

Abducens nerve palsy（ANP） is commonly seen in patients with diabetes mellitus. The validity of acupuncture as a traditional Chinese medicine method in peripheral nerve repair is well established. However, its efficacy in randomized controlled trials remains unclear. Herein, we designed a protocol for a prospective, single-center, randomized controlled trial to investigate the effect of intraorbital electroacupuncture on diabetic ANP. We plan to recruit 60 patients with diabetic ANP, and randomly divide them into treatment and control groups. Patients in both groups will continue their glucose-lowering therapy. A neural nutrition drug will be given to both groups for six weeks. The treatment group will also receive intraorbital electroacupuncture therapy. We will assess efficacy of treatment, eyeball movement, diplopia deviation and the levels of fasting blood-glucose and glycosylated hemoglobin before treatment at 2, 4, and 6 weeks after treatment. The efficacy and recurrence will be investigated during follow-up（1 month after intervention）. This protocol was registered at Chinese Clinical Trial Registry on 16 January 2015（Chi CTR-IPR-15005836）. This study was approved by the Ethics Committee of First Affiliated Hospital of Harbin Medical University of China（approval number： 201452）. All protocols will be in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be provided by participants. We envisage that the results of this clinical trial will provide evidence for promoting clinical use of this new therapy for management of ANP.

Effects of combination pharmacotherapy and social skills training for schizophrenia: A randomized controlled trial

Pharmaco-psychosocial treatment (PPST) refers to a treatment paradigm combining pharmacotherapy with psychosocial therapy. We conducted an 18-month randomized controlled tracking study to evaluate the efficacy of social skills training (SST) in 11 individuals with schizophrenia on risperidone monotherapy. They were randomized to either SST or non-SST group, and Global Assessment Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS) scores in the 2 groups showed gradual improvement. In the SST group, Digit Span Distraction Test (DSDT) at 12 and 18 months showed significant improvement. The Subjective Deficit Syndrome Scale (SDSS) scores in the SST group showed significant improvement after 6 months and showed a significant difference in comparison between the groups. After the subjective feeling of health was recovered, the items of motivation were recovered as a direct effect of SST. Some items of the Life Assessment Scale for the Mentally Ill (LASMI) score showed significant improvement (or significant trend) in only the SST group after 6 months. Items of daily life, work skills, and self-recognition were continuously improved. We report 2 cases in the SST group that had DSDT improvement in parallel with change of action and communication as a change of social function. This study is only exploratory due to the small number of cases. However, we have demonstrated potential improvement in cognitive function due to learning experiences that required working memory and attention, thus providing improvement in social life.

蒲地蓝消炎口服液治疗小儿支原体肺炎有效性和安全性的Meta分析

目的:系统评价中成药蒲地蓝消炎口服液联合西药治疗小儿支原体肺炎(MPP)的临床有效性和安全性。方法:通过全面检索关于蒲地蓝消炎口服液联合西药治疗小儿支原体肺炎的随机对照试验(RCT)文献,利用统计软件RevMan5.3提取并分析数据。结果:共纳入13项研究,共包含1313例患者,其中观察组661例,对照组652例。蒲地蓝消炎口服液联合西药治疗小儿支原体肺炎,临床有效率高于单用西药(RR=1.17,95%CI为1.13~1.22,P<0.0001),退热时间(MD=-1.29,95%CI为-1.35~-1.22,P<0.0001),听诊肺部啰音消退时间(MD=-1.77,95%CI为-1.85~-1.69,P<0.0001)及咳嗽症状消退时间(MD=-2.59,95%CI为-2.67~-2.52,P<0.0001)4个方面均优于单用西药。GRADE评价结果显示证据质量以低质量为主。结论:蒲地蓝消炎口服液联合西药优于单独应用西药,且不良反应较少,安全性较好。

血液透析患者疑难自体动静脉内瘘扣眼穿刺管理方案的设计与临床实证研究

目的构建疑难自体动静脉内瘘扣眼穿刺管理方案,并探讨其在血液透析患者中的应用效果。方法基于文献回顾及专家函询法构建疑难自体动静脉内瘘扣眼穿刺管理方案。设计扣眼穿刺信息交接单和扣眼穿刺示意图。选取2020年9月—2022年1月浙江省某三级甲等医院血液净化中心收治的77例伴有疑难自体动静脉内瘘的血液透析患者为研究对象,按随机数字表法将其分入试验组(n=38)、对照组(n=39)。对试验组采取疑难自体动静脉内瘘扣眼穿刺管理方案,对对照组采取常规扣眼穿刺管理方案。比较两组钝针一次进针成功率、动静脉内瘘感染率、扣眼穿刺处血管内膜增生度及扣眼使用寿命≥12个月者占比。结果试验组钝针一次进针成功率高于对照组,扣眼穿刺处血管内膜增生度低于对照组,扣眼使用寿命≥12个月者占比高于对照组(P<0.05);两组动静脉内瘘感染率比较,差异无统计学意义(P>0.999)。结论疑难自体动静脉内瘘扣眼穿刺管理方案在血液透析患者中的应用可提高钝针一次进针成功率,延缓扣眼穿刺处血管内膜增生,延长动静脉内瘘扣眼使用寿命,值得推广、应用。

针刺联合常规治疗干预慢性心力衰竭疗效的Meta分析

目的:采用Meta分析评价针刺联合常规治疗干预慢性心力衰竭(CHF)的临床疗效。方法:检索中国知网(CNKI)、万方、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、the Cochrane Library、EMbase等数据库自建库至2024年5月1日有关针刺联合常规治疗慢性心力衰竭的随机对照试验(RCTs)。采用Stata 16.0软件进行Meta分析。结果:共纳入26项研究,均为RCTs,涉及2243例CHF病人。Meta分析结果显示,针刺联合常规治疗方法可改善CHF病人心力衰竭总有效率[RR=1.23,95%CI(1.17,1.30),P<0.001]、提高左室射血分数(LVEF)[WMD=4.43,95%CI(2.33,6.53),P<0.001]、延长6 min步行试验(6MWT)距离[WMD=46.48,95%CI(29.93,63.03),P<0.001]、降低血清脑钠肽水平(BNP)[WMD=-143.10,95%CI(-204.86,-81.33),P<0.001]、降低明尼苏达心力衰竭生活质量调查表(MLHFQ)评分[WMD=-5.33,95%CI(-9.88,-0.79),P<0.001]。结论:现有证据表明,针刺联合常规治疗可显著改善CHF病人的临床疗效。

近5年针灸治疗围绝经期失眠随机对照试验的特征分析及质量评价

目的:总结分析针灸治疗围绝经期失眠的随机对照临床试验研究特征,评价其方法学质量与针刺干预措施的报告质量,为今后开展相关研究提供参考。方法:通过计算机检索6个中英文数据库,筛选以针灸疗法为主治疗围绝经期失眠的随机对照试验,提取其研究特征,运用Cochrane偏倚风险评估工具及针刺临床试验干预措施报告规范(STRICTA)对照检查清单进行评价。结果:共纳入文献92篇,其中针刺研究57篇(64.1%),耳穴疗法研究20篇(21.7%)。其诊断标准以教材和指南为主,结局指标以量表为主,研究多聚焦于针灸与其他疗法的优势比较。Cochrane偏倚风险评估结果发现,大部分研究在随机序列的生成(64.1%)、分配隐藏(19.6%)、受试者和干预提供者盲法(0%)、结局评价者盲法(15.2%)方面报告率较低。对照STRICTA条目发现,报告完整度分别为用针数量0篇、进针深度39篇(50.6%)、针具类型42篇(54.5%)、治疗场所信息0篇,治疗师背景4篇(5.2%)。结论:目前针灸治疗围绝经期失眠的随机对照试验的报道多见于国内,其方法学质量与针刺相关报告质量偏低,提示未来相关临床试验需进一步完善和规范试验设计与报告。

温针灸联合盆底肌训练治疗压力性尿失禁临床疗效的Meta分析

目的:对温针灸联合盆底肌训练治疗压力性尿失禁(stress urinary incontinence,SUI)相关文献进行Meta分析,为温针灸联合盆底肌训练治疗压力性尿失禁提供循证医学依据。方法:以温针灸、尿失禁、压力性尿失禁等为主题词,检索PubMed、Cochrane图书馆中心数据库、Embase、中国生物医学文献数据库(CBM)、中国知网数据库(CNKI)、万方数据知识服务平台(Wanfang Data)、维普期刊全文数据库(VIP),检索时限均为自建库至2022年11月。参照Cochrane系统评价的要求,对选择纳入的临床试验进行方法学质量评估、数据提取和数据分析。结果:共纳入11个研究,774例患者,与常规只进行单一的盆底肌训练治疗相比,Meta结果分析显示,温针灸联合盆底肌训练组治疗SUI总有效率高于对照组[OR=4.02,95%CI(2.58,6.26),P<0.00001];ICI-Q-SF评分[MD=-1.17,95%CI(-1.63,-0.7),P<0.00001];1 h尿垫试验[MD=-1.65,95%CI(-2.07,-1.23),P<0.00001],差异具有统计学意义;纳入文献均未报告不良反应。结论:温针灸联合盆底肌训练治疗压力性尿失禁,对提高患者的生活质量、减少漏尿量有较好的疗效。

四君子汤加减联合西医常规疗法治疗胃癌的有效性及安全性Meta分析

目的:系统评价四君子汤加减联合西医常规疗法治疗胃癌的疗效及安全性。方法:检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库以及PubMed、Embase、Cochrane Library、Web of Science等数据库,检索时间均从建库至2022年2月17日,纳入四君子汤加减联合西医常规疗法治疗胃癌的随机对照试验,根据Cochrane协作网偏倚风险评价标准对纳入研究进行方法学质量评价并采用RevMan 5.4软件进行Meta分析,得出结论。结果:共纳入17篇文献,1 338例患者。分析结果显示,四君子汤加减联合西医常规疗法治疗胃癌在提高临床总有效率、Karnofsky功能状态评分量表(Karnofsky Performance Status,KPS)评分,改善免疫功能指标T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平、患者生活质量、术后恢复,降低肿瘤标志物(糖类抗原-199)水平以及焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分、抑郁自评量表(Self-rating Depression Scale,SDS)评分,减少不良反应方面等均优于西医常规疗法。结论:四君子汤加减联合西医常规疗法治疗胃癌疗效优于西医常规治疗,且安全性较高。但受纳入文献质量和数量的影响,上述结论仍需有更多大样本、多中心随机对照试验进一步验证。

氟哌噻吨美利曲辛治疗慢性便秘有效性与安全性的系统评价

目的 系统评价氟哌噻吨美利曲辛治疗慢性便秘临床疗效和安全性。方法 计算机检索Pub Med、Web of Science、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)、万方(Wan Fang)、美国临床试验数据库(Clinical Trials)和中国临床试验注册中心数据库(Chinese Clinical Trial Registry),搜集有关氟哌噻吨美利曲辛治疗慢性便秘的随机对照试验(RCTs),检索时限均从建库至2022年11月13日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.4和Stata MP 14软件进行Meta分析。结果共纳入17篇文献,涉及1 428例慢性便秘患者。Meta分析结果显示,联合使用氟哌噻吨美利曲辛治疗慢性便秘与单独使用便秘常用药物相比,总有效率[OR=3.66,95%CI=(2.76,4.85),P <0.05]更高,改善排便困难[OR=-0.82,95%CI=(-1.34,-0.29),P <0.05]、排便频率[OR=-1.50,95%CI=(-2.45,-0.55),P <0.05]、粪便性状[OR=-1.05,95%CI=(-1.59,-0.51),P <0.05]和焦虑[OR=-3.37,95%CI=(-5.03,-1.71),P <0.05]、抑郁[OR=-4.60,95%CI=(-6.91,-2.29),P <0.05]症状的疗效更优,但不良反应发生率[OR=2.05,95%CI=(1.09,3.88),P <0.05]更高。结论 氟哌噻吨美利曲辛治疗慢性便秘比单独使用便秘常用药物有效率更高,改善患者便秘和精神症状更佳,而不良反应发生率可能也更高。受纳入研究的质量限制,上述结论尚待更多高质量研究予以验证。

Curative effect of Dingqi analgesic patch on cancer pain:a single-blind randomized controlled trail

OBJECTIVE:To observe the curative effect of an acupoint application with a Dingqi analgesic patch on moderate to severe pain caused by liver cancer.METHODS:Forty patients with moderate to severe pain caused by liver cancer were randomly divided intoatreatmentgroup(TG)andacontrolgroup(CG).Patients with moderate pain were given 100 mg qd of a sustainably released tablet of tramadol hydrochloride;patientswithseverepainweregiven4.2mg q3d of the fentanyl transdermal system.The ashi points Ganshu(BL 18),Danshu(BL 19) and Qimen(LR 14) were chosen for the acupoint application intervention.CG patients were given a sham patch and TG patients were given a Dingqi analgesic patch.A visual analogue scale(VAS) was used before treatment and after 1,3,6,9 and 12 days of treatment.The Karnofsky score was measured before treatment and after 12 days of treatment.Any main adverse reactions(e.g.nausea,constipation,dizziness and headache) were recorded after 6 and 12 days of treatment.Any skin side effects(i.e.skin irritation and allergic reactions) were recorded.RESULTS:The VAS in TG was significantly lower than that in CG after 3,6,9 and 12 days of treatment(P<0.05).There was no significant difference in the Karnofsky score before treatment and after 12 days of treatment between CG and TG.There were also no significant differences in the main adverse reactions or skin side effects after 6 and 12 days of treatment between CG andTG(P>0.05).CONCLUSION:The Dingqi analgesic patch can enhance the analgesic effect of tramadol and fentanyl.

舒适护理对脑卒中患者应用效果的meta分析

目的 系统评价舒适护理对脑卒中患者的应用效果。方法 计算机检索中国知网、万方医学网、维普资讯中文期刊服务平台、中国生物医学文献服务系统、PubMed、Cochrane Library、Web of Science等国内外数据库中有关舒适护理对脑卒中患者应用效果的随机对照试验,检索时间从建库至2022年12月。由2名研究者根据纳入及排除标准独立筛选文献、提取资料并进行质量评价,采用RevMan5.3软件进行meta分析。结果 共纳入文献15篇,1 437例研究对象,其中观察组720例,对照组717例。观察组患者日常生活能力、运动能力、护理满意度均明显高于对照组(标准均数差=1.47、2.71,95%可信区间:1.04~1.89、0.97~4.45,P<0.000 01),抑郁评分、焦虑评分均明显低于对照组(标准均数差=-1.41、-0.91,95%可信区间:-1.77~-1.04、-1.22~-0.61,P<0.000 01)。结论 舒适护理可明显提高脑卒中患者的日常生活能力及运动能力,降低脑卒中患者的焦虑及抑郁水平,并有利于提高患者对护理的满意度。

Immediate analgesic effect of needling acupoints(bilateral De Qi vs unilateral De Qi)on primary dysmenorrhea:a multi-center,randomized,controlled trail

OBJECTIVE: To analyze the effect of needling acupoints(bilateral vs unilateral) with De Qi using data collected from 501 primary dysmenorrhea(PD) patients participating in multi-center, randomized,controlled trail.METHODS: De Qi was defined as at least one of the feelings in soreness, numbness, fullness or heaviness at the acupoints when stimulated with needles. The 501 patients were grouped in 3 groups in terms of De Qi or not De Qi in one side(unilateral)or both sides(bilateral) of the body: bilateral De Qi group, unilateral De Qi group, and non-De Qi group. The abdominal pains were measured using visual analog scale(VAS).RESULTS: In 501 patients, 472 acquired De Qi at unilateral acupoints, 24 De Qi at bilateral acupoint,and 5 had no De Qi at any acupoint. The data of non-De Qi group was excluded as the sample was less than 5% of that in the bilateral De Qi group.There was significant difference in the VAS before and after treatment between unilateral and bilateral De Qi group(P < 0.01). After stratified by acupoints, for the patients needled at Sanyinjiao(SP 6)and Xuanzhong(GB 39), VAS scores in the bilateral De Qi group were larger than those in the unilateral De Qi group(P < 0.05).CONCLUSION: Bilateral De Qi was possibly superior to unilateral De Qi in enhancing the immediate analgesic effect of needling the acupoints, but no statistical significance was observed on the pa-tients of needling at non acupoint, which preliminarily suggested this immediate analgesic effect was perhaps along meridians.

复方伊贝沙坦治疗轻中度高血压的疗效和安全性

目的 :评价伊贝沙坦与氢氯噻嗪 (复方伊贝沙坦 )降压疗效和安全性。 方法 :①采用多中心、随机、双盲、平行对照试验 (简称对照试验 ) ,选择轻中度高血压患者 2 48例 ,随机入伊贝沙坦 15 0～ 3 0 0mg与氢氯噻嗪 12 5mgQd或伊贝沙坦 15 0～ 3 0 0mgQd治疗 ,共 8周。治疗前、治疗后 4周和治疗后 8周进行降压疗效及安全性分析。②采用开放试验 ,选择轻中度高血压患者 2 8例 ,日服伊贝沙坦 15 0mg与氢氯噻嗪 12 5mgQd ,共 8周 ,治疗前后行 2 4h动态血压监测并计算降压有效患者的收缩压、舒张压谷 /峰值。 结果 :对照试验降压疗效 :治疗 4周末复方伊贝沙坦组和伊贝沙坦组的坐位舒张压 (SeDBP)及坐位收缩压 (SeSBP)较治疗前下降幅度明显 (P =0 0 2 3 2 ,P =0 0 0 45 )。治疗 8周末两组的SeDBP及SeSBP仍明显下降 ,但复方伊贝沙坦组下降更明显 (P =0 0 118,P =0 0 2 0 1) ;治疗 8周末复方伊贝沙坦组较伊贝沙坦组的SeDBP及SeSBP降压幅度均明显 (P <0 0 5 )。复方伊贝沙坦组降压总有效率 76 47% ,高于伊贝沙坦组的 61 16% (P =0 0 10 )。开放试验部分 :收缩压及舒张压谷 /峰值分别为 5 6 1%、 5 5 3 %。 结论 :复方伊贝沙坦降压安全有效、作用强于伊贝沙坦 ,可 2 4h平稳降压。

0.05％环孢素A滴眼液治疗干眼的有效性和安全性临床评价

背景 干眼是常见的眼表疾病,质量分数0.05％环孢素A是一种免疫抑制剂,国外的研究表明其对干眼具有治疗作用,但中国尚未批准将0.05％环孢素A滴眼液用于干眼治疗. 目的 研究0.05％环孢素A治疗干跟的有效性和安全性. 方法 采用随机、双盲、安慰剂平行对照的优效试验方法,纳入2010年10月至2011年2月在四川大学华西医院确诊的干眼患者40例40眼,采用随机卡片法将经筛选期、基线期以及再次核查后符合纳入标准的患者随机分为2个组,2个组患者均给予羟丙基甲基纤维素滴眼液点眼作为基础治疗,同时分别给予0.05％环孢素A滴眼液（Ⅱ）和环孢素A滴眼液（Ⅱ）溶媒点眼84 d.患者均于用药后（7±1）、（28±2）、（56±3）、（84±3）d以及停药后14 d进行复查,将用药前后眼部症状、体征以及干眼相关检查指标作为有效性评价指标,将用药前后视力的改变、用药后不适感、全身安全性以及不良事件作为安全性评价指标,评估0.05％环孢素A滴眼液治疗干眼的有效性和安全性. 结果 治疗前后0.05％环孢素A滴眼液组和溶媒组的眼部症状评分、结膜充血评分、泪膜破裂时间（BUT）、Schirmer试验Ⅰ（SⅠ t）、角膜结膜染色总评分明显不同,差异均有统计学意义（均P＜0.01）.0.05％环孢素A滴眼液组和溶媒组的临床总有效率分别为75％（15/20）和25％ （5/20）,组间比较差异有统计学意义（P=0.000）,0.05％环孢素A滴眼液组与溶媒组总有效率的差值的95％可信区间（CI）为30.80％ ～53.75％,证实0.05％环孢素A组较溶媒组的统计优效成立.治疗后84d2个组受试者视力的差异无统计学意义（P=0.890）.大多数受试者用药后眼部无不适感,少数有轻中度不适.结论 0.05％环孢素A滴眼液（Ⅱ）对于治疗干眼有较好的疗效,并且具有良好的安全性.

中医药分期二步法治疗溃疡性结肠炎的临床研究

目的观察中医药分期二步法干预方案治疗溃疡性结肠炎的临床疗效和优势。方法 53例轻、中度初发或复发型溃疡性结肠炎活动期湿热内蕴证患者随机分为中药组27例及西药组26例。中药组活动期予清肠化湿方口服联合灌肠方外治;缓解期扶正清肠方口服,若病情复发加用灌肠方,同时根据症状特点进行对症加减。西药组活动期给予美沙拉嗪肠溶片1.0g,每日4次口服治疗;缓解期给予美沙拉嗪肠溶片0.5g,每日3次口服治疗,若病情复发恢复为活动期治疗方案。分别于治疗后28、56、84天观察患者主要临床症状、中医证候、诱导缓解率和生活质量变化。结果治疗84天后,中药组腹泻、脓血便、腹痛均较治疗前明显好转(P<0.05),且对腹泻、脓血便的缓解优于西药组(P<0.05)。中药组治疗28、56、84天后,中医证候疗效分别为77.78%、77.78%、88.89%,诱导缓解率分别为63.0%、77.8%、88.9%,均优于同期西药组(P<0.05)。治疗84天后,两组患者生活质量各维度胃肠症状、全身症状、情感能力、社会能力等方面较治疗前均显著改善(P<0.05),且中药组患者生活质量各维度改善程度均优于西药组(P<0.05)。结论中医药分期二步法干预方案能有效改善溃疡性结肠炎患者的主要临床症状,改善患者中医证候,提高溃疡性结肠炎缓解率和患者整体生活质量,具有良好的临床疗效。

多巴胺与去甲肾上腺素治疗感染性休克患者安全性的Meta分析

目的对多巴胺与去甲肾上腺素治疗严重感染性休克病人的安全性进行分析。方法系统检索PubMed和Embase,考克兰随机对照试验及中国知网等电子数据库,纳入对比多巴胺与去甲肾上腺素治疗感染性休克病人的随机对照试验。结果共纳入7项随机对照试验,总计1 456名病人。去甲肾上腺素组病人住院期间死亡风险明显低于多巴胺组（RR=1.11,95%CI：1.00-1.23,P=0.04）。去甲肾上腺素组病人发生心律失常风险明显低于多巴胺组（RR=2.31,95%CI：1.39-3.86,P=0.001）。两组病人用药后平均动脉压无明显差异（SMD=-0.58,95%CI：-1.75~0.60,P=0.34）。结论目前现有的证据表明,相比于多巴胺,去甲肾上腺素治疗感染性休克病人在安全性问题上具有明显的优势。因此,可以考虑将去甲肾上腺素作为感染性休克病人的首选用药。然而,对待我们的结论需要谨慎,因为,本荟萃分析纳入研究的样本总量较小。多巴胺对比去甲肾上腺素治疗感染性休克病人的安全性问题需要将来纳入更多的随机对照试验进行更深入的研究和探讨。

瑞格列奈对比格列美脲分别联合二甲双胍治疗2型糖尿病有效性和安全性的Meta分析

目的:系统评价瑞格列奈对比格列美脲分别联合二甲双胍治疗2型糖尿病的有效性和安全性,为临床提供循证依据。方法:计算机检索中国期刊全文数据库、中文科技期刊数据库、万方数据库、Pub Med、Embase、Medline、Cochrane图书馆,收集瑞格列奈联合二甲双胍(试验组)对比格列美脲联合二甲双胍(对照组)治疗2型糖尿病疗效[糖化血红蛋白(Hb A1c)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平]和安全性(不良反应发生率、低血糖反应发生率、胃肠道反应发生率)的随机对照试验(RCT),对符合纳入标准的文献进行资料提取,并采用Cochrane系统评价手册5.1.0进行质量评价后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入12项RCT,合计957例患者。Meta分析结果显示,试验组患者2 h PG降低程度显著低于对照组,差异有统计学意义[MD=-0.70,95%CI(-1.02,-0.38),P<0.001];两组患者Hb A1c降低水平[MD=0.00,95%CI(-0.24,0.25),P=0.98]、FPG降低水平[MD=0.10,95%CI(-0.17,0.36),P=0.47]、不良反应发生率[OR=0.54,95%CI(0.28,1.06),P=0.07]、低血糖反应发生率[OR=0.52,95%CI(0.13,2.06),P=0.35]和胃肠道反应发生率[OR=0.60,95%CI(0.15,2.41),P=0.47]比较,差异均无统计学意义。结论:瑞格列奈联合二甲双胍降低2 h PG效果优于格列美脲联合二甲双胍,安全性相当。

头孢美唑钠注射剂治疗呼吸系统感染的随机、双盲、多中心临床试验

目的评价国产注射用头孢美唑钠治疗中、重度呼吸系统细菌性感染的临床疗效和安全性。方法采用双盲、随机对照、多中心试验设计,以进口头孢美唑钠为对照药物。两组均为每次静脉滴注给药2．0g,q12h,疗程均为5～12d。结果本次试验共入选病例144例,两组各为72例。可纳入临床疗效ITT分析和PP分析的病例数,试验组分别为70例和66例；对照组分别为67例和65例。治疗结束时试验组和对照组总的临床有效率分别为78．79%和81．54%,两组细菌清除率分别为91．67%和85．71%,不良反应发生率分别为5．56%和8．33%。以上结果经统计学处理均无显著性差异。结论国产头孢美唑钠注射剂治疗敏感细菌引起的中、重度呼吸道感染的临床疗效确切,安全性好。