通腑泻下法联合机械通气治疗ALI/ARDS的系统评价  

Tongfuxiexia Method Plus Mechanical Ventilation in ALI/ARDS:A Systematic Review of Randomized Controlled Trials

作　　者：朱际平[1] 孙子凯[1] 李磊[1] 吴刚[1] 赵俊[2] 周贤梅[1] 

机构地区：[1]江苏省中医院,江苏南京210029 [2]南京中医药大学第一临床医学院,江苏南京210029

出　　处：《中国中医急症》2013年第10期1690-1692,1702,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：江苏省中医药管理局科技项目资助课题(IL11028)

摘　　要：目的评价使用中药通腑泻下,联合机械通气和西医常规方法治疗急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的临床疗效。方法收集使用通腑泻下中药大黄或大承气汤等中药复方,以口服、鼻饲、灌肠、联合机械通气和西医常规治疗,救治ALI/ARDS的随机对照试验(RCT)研究文献。按照纳入和排除标准进行筛选,质量评价和数据提取。采用RevMan5.1.7统计软件进行数据分析。结果共纳入18个RCT研究文献。其中15个研究报道了病死率,其中12个RCT未显示死亡风险降低。14个RCT报道了治疗后氧合指数,其中11个RCT显示氧合指数得到改善。7个RCT报道了对机械通气时间的观察,5个RCT显示可减少机械通气时间。结论通腑泻下法联合机械通气和西医常规治疗不能降低死亡风险,可改善氧合指数,减少机械通气时间。但这一结论还需要高质量的随机对照研究证实。Objective：To evaluate the clinical curative efficacy and the safety of Chinese herbal medicine with Tongfuxiexia method in treating ALI/ARDS,combined with mechanical ventilation and normal methods of western medicine.Methods：CNKI （from 1979 to April,2013）,Wanfang Database （from 1998 to April,2013）,PubMed （from 1996 to April,2013）,and Cochrane Liberary-Cochrane Central Register of Controlled Trials（Issue 3 of 12,March,2013） had been searched,computer-and hand-retrieved,for the literature on randomized controlled trials （RCT） in treating ALI/ARDS with Chinese herbal medicine with Tongfuxiexia method and Chinese native medicine compound prescription by oral administration,nasal feeding or coloclysis,combined with mechanical ventilation and normal methods of western medicine.Trial screening,quality-assessment of included trials and data extraction were conducted according to the criteria for incorporation and elimination.The statistics were analyzed by RevMan 5.1.7 software.Results：A total of 18 Chinese randomized controlled trials （RCTs） were identified.No pooled analysis was performed because of the significant heterogeneity among the included trials.The findings fall into 3 categories as follows：（1）15 RCTs reported the mortality,and only 3 indicated Chinese herbal medicine was more effective in reducing the mortality risk; （2）14 RCTs reported the post-treatment oxygenation index,and 11 RCTs showed that Chinese herbal medicine could improve the oxygenation index; （3）7 RCTs reported the observation on the time of mechanical ventilation,and 5 RCTs revealed that Chinese herbal medicine could help to reduce the time of mechanical ventilation.And no obvious adverse reaction to Chinese herbal medicine was reported.Conclusion：The current evidence illustrates that Chinese herbal medicine is not effective in reducing the mortality risk,but it can improve the oxygenation index and reduce the time of mechanical ventilation.However,this conclusion remains to be confirmed by more co

关 键 词：急性肺损伤 急性呼吸窘迫综合征 系统评价 中药 ALI ARDS 

分 类 号：R278[医药卫生—中医学]