中药雾化吸入法联合西医常规疗法治疗慢性阻塞性肺疾病急性加重的系统评价  

Systematic Review on the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease by Chinese Medicine Atomization Inhalation Combined with Western Medicine Routine Therapy

作　　者：俞邦 冯沁祺 黄常芮 刘明非 张洪春[1,2] Yu Bang;Feng Qinqi;Huang Changrui;Liu Mingfei;Zhang Hongchun(Bejing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学,北京100029 [2]中日友好医院,北京100029

出　　处：《中国中医急症》2023年第6期941-946,共6页Journal of Emergency in Traditional Chinese Medicine

基　　金：国家自然科学基金项目(82074367)。

摘　　要：目的系统评价中药雾化吸入法联合西医常规疗法治疗慢性阻塞性肺疾病急性加重(AECOPD)的有效性及安全性。方法计算机检索中国知网、万方数据知识服务平台、维普数据平台、中国生物医学文献数据库、Web of Science、Embase、PubMed和Cochrane Library,检索时间从建库之日到2022年6月7日,筛选中药雾化吸入法联合西医常规疗法治疗AECOPD的随机对照试验。根据Cochrane偏倚风险评估工具进行质量评价,使用RevMan 5.4软件对1秒钟用力呼气容积与用力肺活量比(FEV1/FVC)、最大呼气第1秒呼出气量的容积(FEV1%)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、临床有效率、6分钟步行试验及安全性结局指标进行Meta分析,并根据GRADE标准进行证据质量评价。结果纳入随机对照研究29项,中药雾化吸入法联合西医常规疗法能改善治疗后FEV1/FVC[MD=6.44,95%CI(3.98,8.90)]、FEV1%[MD=8.21,95%CI(4.04,12.39)]、PaO_(2)[MD=8.80 mmHg,95%CI(5.91,11.70)](1 mmHg≈0.133 kPa)、PaCO_(2)[MD=-7.02 mmHg,95%CI(-17.57,3.52)],提高临床有效率[RR=1.21,95%CI(1.16,1.26)],6分钟步行试验的行走距离有增长趋势[MD=25.30 m,95%CI(19.42,31.18)],差异均具有统计学意义(P<0.01),且安全性更高;GRADE评价提示,有效率为中质量证据,FEV1/FVC、FEV1%为极低质量证据。结论中药雾化吸入法联合西医常规疗法治疗AECOPD较为安全,可以改善肺功能、血气等指标,提高疗效,为临床治疗AECOPD提供参考。Objective:To systematically review the efficacy and safety of atomized inhalation of traditional Chi-nese medicine combined with conventional western medicine in the treatment of acute exacerbation of chronic ob-structive pulmonary disease(AECOPD).Methods:CNKI,Wanfang Database,VIP,CBM,Web of Science,Embase,PubMed and Cochrane Library were searched by computer from inception to June 7,2022.Randomized controlled trials of Chinese medicine atomization inhalation combined with western medicine conventional therapy for AECO-PD were screened.The quality was evaluated according to the Cochrane bias risk assessment tool,and the FEV1/FVC,FEV1%,PaO_(2),PaCO_(2),clinical efficiency,six minutes walk test and safety outcome indicators were meta ana-lyzed using RevMan5.4 software,and the evidence quality was evaluated according to GRADE standards.Results:29 randomized controlled studies were included.The combination of traditional Chinese medicine atomization inha-lation and westerm medicine conventional therapy can improve FEV1/FVC[MD=6.44,95%CI(3.98,8.90)],FEV1%[MD=8.21,95%CI(4.04,12.39)],Pa02[MD=8.80 mmHg(1mmHg≈0.133kPa),95%CI(5.91,11.70)],Pa-CO,[MD=-7.02 mmHg,95%CI(-17.57,3.52)],and improve the clinical effective rate[RR=1.21,95%CI(1.16,1.26)].The walking distance in the six minutes walking test had an increasing trend[MD=25.30m,95%CI(19.42,31.18)],and the differences were statistically significant(P<0.01),and the safety was higher.GRADE evaluation indicates that the effective rate was medium quality evidence,and FEV1/FVC and FEV1%were very low-quality evidence.Conclusion:Traditional Chinese medicine atomization inhalation combined with western medicine rou-tine therapy is safe in the treatment of AECOPD,which can improve pulmonary function,blood gas and other indi-cators,improve the efficacy,and provide reference for clinical treatment of AECOPD.

关 键 词：慢性阻塞性肺疾病急性加重 中药雾化吸入 系统评价 

分 类 号：R563.3[医药卫生—呼吸系统]