生脉注射液对急性心肌梗死病死率影响的系统评价

作者	单位
高铸烨	北京中医药大学
郭春雨	中国中医科学院西苑医院
史大卓	中国中医科学院西苑医院
陈可冀	中国中医科学院西苑医院中日友好医院全国中西医结合心血管病中心
徐浩	中日友好医院全国中西医结合心血管病中心
吴泰相	四川大学华西医院循证医学与临床流行病学教研室

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中文摘要:

目的系统评价生脉注射液治疗急性心肌梗死(AMI)对病死率的影响。方法计算机检索Co- chrane数据库(2007年第3期)、PubMed(1980—2007)、EMBASE(1979—2007.4)、OVID(1979—2007.4)、中国生物医学文献光盘数据库(CBM,1979—2007.4)、中国学术期刊全文数据库(CNKI,1980—2007.4)、中文科技期刊数据库(VIP,1989—2007.4),手工检索国内心血管疾病会议论文集,筛选生脉注射液治疗AMI的随机对照试验(RCT)和半随机对照试验。采用Cochrane Handbook for Systematic Reviews of Interventions 4.2.6中的方法进行文献质量评价,应用RevMan 4.2.9软件进行统计分析。结果共纳入4个RCT的376例AMI患者,纳入研究质量均为C级。Meta分析结果显示,使用生脉注射液的治疗组病死率降低[RR:0.18,95%CI(0.04,0.77)],但使用血管活性药物的生脉注射液治疗组病死率降低趋势不明显[RR:0.67,95%CI(0.29,1.51)]。结论根据当前证据,西医常规治疗联用生脉注射液可以降低AMI病死率,但有必要对使用血管活性药物治疗AMI时是否加用生脉注射液及加用的时机、方法进行进一步研究。由于纳入研究质量较低,从这些研究中所获得的证据强度不高,有待更多高质量研究加以验证。

英文摘要:

Objective To systematically evaluate the therapeutic efficacy of Shengmai Injection (SMI) on the fatality rate of patients with acute myocardial infarction (AMI).Methods Literature associated with randomized controlled trials (RCT) or quasi-RCT of SMI in treating patients with AMI were retrieved by computerized searching from Cochrane Central Register of Controlled Trials (Issue 3,2007),PubMed (1980-2007),EMBASE(1979- 2007.4),OVID (1979-2007.4),Chinese Biological Medicine Database (1979-2007.4),CNKI(1980- 2007.4),VIP (1989-2007.4)and those in Chinese Conference Treatises in cardiovascular diseases were hand searched (update to Dec 2006).Quality of them was evaluated with the method recommended in Cochrane Review- er’s Handbook 4.2.6,and statistical analysis was performed using the Cochrane Collaboration’s Bey Man 4.2.9 software.Results Four RCT (conducted in China),involving 376 AMI patients meeting the inclusion criteria were identified.All the included RCT were graded as C.The results of recta-analyses indicated that the fatality rate in the SMI treated group was cut down [RR:0.18,95% CI (0.04,0.77)],but the decreasing trend become in- significant when SMI was used in combination with vasoactive agents [RR:0.67,95% CI(0.29,1.51)].Con- clusions According to the present evidence,the fatality rate can be decreased by combined use of SMI with the conventional therapy of modern medicine. However,it is necessary to do further research on whether SMI is suit- able for combined use with vasoaetive agent,the opportunity and method of doing that way. As the evidence ob- tained is not strong enough due to the rather poor quality of current studies enclosed,further studies with high-qual- ity,large-scale trials are required for identification.

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