益气化瘀法治疗脓毒症疗效的Meta分析  

Meta-Analysis of the Curative Effect of Yiqi Huayu Therapy on Sepsis

作　　者：黄怡 石怡[1] 木其尔[1] 陈伟[1] Huang Yi;Shi Yi;Mu Qier;Chen Wei(Longhua Hospital Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院,上海200032

出　　处：《世界科学技术-中医药现代化》2023年第1期299-311,共13页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：上海市卫生和计划生育委员会中医药三年行动计划项目(ZY(2018-2020)-FWTX-7004):上海市重大危重医疗事件中西医协同响应与干预平台建设,负责人:陈伟。

摘　　要：目的 针对益气化瘀法治疗脓毒症的疗效进行Meta分析,探析该治法在脓毒症中的作用。方法 先后检索中国知网(CNKI)、万方数据库(WF)、维普数据库(VIP)、科学网(Web of Science)、荷兰医学文摘Embase数据库、美国国立医学图书馆PubMed数据库中从建库至2021年12月01日发表的关于益气化瘀法治疗脓毒症患者的随机对照临床试验(Randomized controlled trial RCT)。对照组采用常规治疗措施;治疗组在对照组基础上采用以益气化瘀法为主的中医治疗,包括中草药和中成药。主要观察指标为有效率、28天死亡率、急性生理学与慢性健康状况评分Ⅱ(APACHEII);次要观察指标为序贯器官衰竭评分(SOFA)、中医证候评分、C反应蛋白(CRP)、降钙素原(PCT)、白细胞(WBC)总数、白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D二聚体(D-Di)、血小板(PLT)、血乳酸(Lac)水平等。由2位研究者分别独立检索文献、收集数据及评估偏移风险;应用RevMan 5.3完成统计分析;并进行了安全性分析和敏感性分析,采用漏斗图评价主要观察指标的潜在发表偏倚。结果 共纳入32项RCT研究,包含2200例患者,研究发现采用益气化瘀法治疗脓毒症的总有效率较常规治疗组高,且可降低脓毒症患者28天死亡率,改善APACHEII评分、SOFA评分以及中医证候积分,能够显著降低脓毒症患者外周血WBC、CRP、PCT、TNF-α、IL-6、IL-10水平,缩短PT、APTT,提高外周血PLT水平,降低D-Di和Lac水平。结论 采用益气化瘀法用于治疗脓毒症可有效抑制炎症因子释放,改善凝血功能及组织器官灌注不足,从而降低患者28天死亡率,改善APACHEII评分、SOFA评分以及中医证候积分,可在脓毒症的治疗中发挥有效作用。Objective To conduct a Meta-analysis on the efficacy of Yiqi Huayu method in the treatment of sepsis,and to explore the effect of this treatment in sepsis.Methods Searched randomized controlled trial RCT on the treatment of patients with sepsis by Yiqi Huayu method published on China National Knowledge Infrastructure(CNKI),Wanfang Database(WF),VIP Database(VIP),Web of Science,Embase Database of Dutch Medical Abstracts,and PubMed database of the National Library of Medicine from its establishment to December 1,2021.The control group was given routine treatment;the treatment group was given traditional Chinese medicine treatment based on the method of Yiqi Huayu method,including Chinese herbal medicine and proprietary Chinese medicine.The main outcome measures were response rate,28-day mortality,acute physiology and chronic health status score II(APACHEII);secondary outcome indicators were sequential organ failure score(SOFA),TCM syndrome score,C-reactive protein(CRP),Procalcitonin(PCT),total white blood cells(WBC),interleukin(IL)-6,IL-10,tumor necrosis factor(TNF)-α,prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-Di),platelet(PLT),blood lactate(Lac) levels,etc.Two researchers independently searched the literature,collected data,and assessed the risk of bias.RevMan 5.3 was used to complete the statistical analysis.Safety analysis and sensitivity analysis were also performed,and funnel plots were used to evaluate the potential publication bias of the main observation indicators.Results A total of 32 RCT studies were included,including 2200 patients.The study found that the total effective rate of the method of nourishing qi and removing blood stasis in the treatment of sepsis was higher than that of the conventional treatment group,and it could reduce the 28-day mortality of patients with sepsis and improve the APACHE II score.SOFA score and TCM syndrome score,can significantly reduce the levels of WBC,CRP,PCT,TNF-α,IL-6,IL-10 in peripheral blood of patients with sepsis,shorten PT,APTT,i

关 键 词：脓毒症 益气化瘀法 临床疗效 META分析 

分 类 号：R259[医药卫生—中西医结合]