中西医结合治疗脑卒中失语症疗效的Meta分析及选方用药探讨  

Meta-analysis of Therapeutic Effect of Integrated Traditional Chinese and Western Medicine on Aphasia in Stroke and Its Medication

作　　者：李博[1] 张松兴[2] LI Bo;ZHANG Songxing(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110034,Liaoning,China)

机构地区：[1]辽宁中医药大学,辽宁沈阳110847 [2]辽宁中医药大学附属第二医院,辽宁沈阳110034

出　　处：《实用中医内科杂志》2020年第6期9-16,共8页Journal of Practical Traditional Chinese Internal Medicine

基　　金：全国名老中医药专家传承工作室建设项目(国中医药人教发〔2016〕42)。

摘　　要：目的运用Meta分析方法以系统评价中西医结合治疗脑卒中失语症(stroke aphasia)的临床疗效,并探讨其选方用药的规律,以期更好地指导脑卒中失语症的临床用药,提高脑卒中失语症的临床疗效。方法用计算机系统检索中国学术期刊全文数据库(CNKI)、中国科技期刊全文数据库(VIP)、万方数据库(Wan Fang Data)、Pub Med、The Cochrane Library等数据库,检索时间范围为从建库到2019年6月,纳入全部有关脑卒中失语症的随机对照试验(RCT),并用改良Jadad记分法对纳入的试验进行文献质量评价。采用Rev Man5.3软件进行Meta分析,并对纳入方剂的中药进行频次和种类统计。共纳入11个随机对照试验,患者共计820例。结果治疗组的有效率比对照组显著提高,由68.45%(256/374)提高到86.07%(315/366)(P<0.01),其合并效应量OR=2.74,95%CI(1.50,4.99),Z=3.29(P=0.001),差异有显著性意义;中药配合西医常规治疗治疗脑卒中失语症对改善患者的语言功能[WMD=26.47,95%CI(6.36,46.59),Z=2.58(P=0.010)]、谈话能力[WMD=4.56,95%CI(3.11,6.01),Z=6.17(P<0.00001)]、理解能力[WMD=7.09,95%CI(3.95,10.23),Z=4.43(P<0.00001)]、复述能力[WMD=11.95,95%CI(5.89,18.01),Z=3.86(P=0.0001)]、命名能力[WMD=6.80,95%CI(2.20,11.41),Z=2.90(P=0.004)]、阅读能力[WMD=5.77,95%CI(4.96,6.57),Z=14(P<0.00001)]、书写能力[WMD=17.67,95%CI(2.91,32.44),Z=2.35(P=0.02)]、CFCP评分[WMD=7.21,95%CI(2.22,12.19),Z=2.83(P=0.005)]的疗效与对照组有显著性差异。将11篇纳入文献剔除相同的方剂,总共纳入9首方剂。统计9首方剂的主方用药频次,暂不统计主方后的加减用药,其中总共有65味中药,每一味中药的使用频次总和为90次。其中,运用频次较高的中药主要为石菖蒲、远志、川芎、甘草、胆南星等;中药种类主要为补虚药、平肝息风药、活血化瘀药、清热药等。结论相比于单一的西医治疗,中西医结合治疗脑卒中失语症的临床疗效较高,并且中医用药�Objective To systematically evaluate the clinical efficacy of combination of traditional Chinese and Western medicine in the treatment of stroke aphasia and explore the rules of prescriptions in order to better guide the clinical use of stroke aphasia and improve the clinical efficacy of aphasia.Methods The Chinese academic journal full-text database(CNKI),Chinese scientific journal full-text database(VIP),Wanfang database(Wan Fang Data),Pub Med,The Cochrane Library and other databases were searched by computer system.The retrieval time ranged from database building to 2019.In June,all randomized controlled trials(RCT)on stroke aphasia were included,and the quality of the included trials was assessed using the modified Jadad score.The Meta-analysis was performed using Rev Man5.3 software,and the frequency and type statistics of the Chinese medicines included in the prescription were performed.A total of 11 randomized controlled trials were included,with a total of 820 patients.The Meta-analysis showed that the effective rate of the treatment group was significantly higher than that of the control group[68.45%(256/374)vs 86.07%(315/366)](P<0.01),and the combined effect was significant[OR=2.74,95%CI(1.50,4.99),Z=3.29(P=0.001)].Traditional Chinese medicine combined with Western medicine treatment of stroke aphasia improved the language function of patients[WMD=26.47,95%CI(6.36,46.59),Z=2.58(P=0.010)],talk ability[WMD=4.56,95%CI(3.11,6.01),Z=6.17(P<0.00001)],comprehension[WMD=7.09,95%CI(3.95,10.23),Z=4.43(P<0.00001)],recap ability[WMD=11.95,95%CI(5.89,18.01),Z=3.86(P=0.0001)],naming ability[WMD=6.80,95%CI(2.20,11.41),Z=2.90(P=0.004)],reading ability[WMD=5.77,95%CI(4.96,6.57),Z=14(P<0.00001)],writing ability[WMD=17.67,95%CI(2.91,32.44),Z=2.35(P=0.02)],CFCP score[WMD=7.21,95%CI(2.22,12.19),Z=2.83(P=0.005)],which were significantly more effective than those of the control group.Eleven articles were excluded from the literature,and a total of nine prescriptions were included.We counted the frequency of the main prescript

关 键 词：脑卒中失语症 中西医结合 META分析 临床疗效 选方用药 方剂 中药频次 中药种类 

分 类 号：R256[医药卫生—中医内科学]