基于GRADE系统的两种钙通道阻滞剂联合治疗高血压的循证实践  

Evidence-based practice of dual calcium channel blockers treating hypertension based on GRADE system

作　　者：杨忆 匡扶[2] 王娜[2] 付钰莹 余娴[2] YANG Yi;KUANG Fu;WANG Na;FU Yu-ying;YU Xian(School of Pharmacy, Chongqing Medical University, Chongqing 400016;The Seconed Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China)

机构地区：[1]重庆医科大学药学院,重庆400016 [2]重庆医科大学附属第二医院,重庆400010

出　　处：《川北医学院学报》2018年第2期148-153,共6页Journal of North Sichuan Medical College

基　　金：重庆市卫生计生委重点项目(2016ZDXM010)

摘　　要：目的:采用GRADE系统评价方法评估临床实践中两种钙通道阻滞剂(calcium channel blocker,CCB)联合治疗高血压的循证证据,以期建立一种可行的寻找药物治疗方案循证证据的工作方法,促进临床合理用药。方法:将两种CCB联合治疗高血压这一临床问题根据PICO原则转换后,检索相关数据库,按设定标准对结果进行筛选和证据质量评级,再对每一个结局指标做综合性评价,最终判断药物治疗方案的合理性。结果:两种CCB联合治疗高血压有循证证据,但证据质量低。具体联合方案为二氢吡啶类(dihydropyridine,DHP)联合非二氢吡啶类(nondihydropyridine,NDHP)。与单用DHP相比,DHP与NDHP联合治疗可使血压下降、心率减慢;与单用NDHP相比,联合治疗可使血压下降、心率加快;与单用DHP或NDHP相比,联合治疗不良反应发生率降低。结论:GRADE是一种可行的评估药物治疗方案循证证据的有效方法,结果表明,DHP与NDHP联合治疗高血压疗效增加,不良反应发生率降低,但证据质量低,需开展大样本、多中心的高质量RCT进一步验证联合用药方案的有效性及安全性。Objective： Applying GRADE system to evidence-based evaluate the rationality of dual calcium channel blockers（ CCB） treating hypertension,we try to establish a feasible method of evidence-based evaluation of pharmacotherapeutic schemes,and promote the rational use of medicines. Methods： The two kinds of CCB combined treatment of the clinical problem of hypertension according to the principle of PICO conversion,retrieval related database,according to the set standards for screening and evidence of quality rating results. Then,the evidence quality of original research was rated and each outcome index was comprehensively evaluated. Finally,the rationality of the medicine treatment scheme was evaluated. Results： Dual CCB,namely dihydropyridine（ DHP） and nondihydropyridine（ NDHP）,in the treatment of hypertension was graded as evidence-based medicine,but the evidence quality was relatively low. Compared with DHP,dual CCB reduced both blood pressure and the heart rate. Compared with NDHP,dual CCB reduced blood pressure and increased the heart rate. Dual CCB had lower incidence of adverse drug reaction in comparison with monotherapy. Conclusion： The GRADE system is an effective method of evidence-based evaluation of pharmacotherapeutic schemes. This result shows that combination therapy of DHP and NDHP increased the therapeutic effects and decreased the adverse drug reactions. However,since the evidence quality is relatively low,more large-sample,multicenter,and high-quality RCTs are required to further proof the efficiency and safety of this combined therapy.

关 键 词：循证实践 GRADE系统 高血压 钙通道阻滞剂 二氢吡啶类 非二氢吡啶类 

分 类 号：R956[医药卫生—药学]