摘要
目的系统评价中药液冲洗治疗对慢性鼻窦炎鼻内镜术后术腔恢复的临床疗效和安全性。方法计算机检索PubMed(1980.1～2009.1)、MEDLINE(1980～2009)、EBSCOhost(1975.1～2009.1)、CALIS外文期刊网(1984～2009)、CNKI(1979～2007)、VIP(1989～2009)、CBM(1978～2009),并手工检索《中华耳鼻咽喉头颈科杂志》(1990～2008)、《临床耳鼻咽喉头颈外科杂志》(1988～2008)、《耳鼻咽喉头颈外科》(1990～2008)、《中国中西医结合耳鼻咽喉科杂志》(1996～2008)等,收集慢性鼻窦炎鼻内镜术后使用中药冲洗治疗的随机对照试验(RCT)。按纳入与排除标准筛选试验、提取资料和评价质量,而后采用RevMan 4.2.10软件进行统计分析。结果 3个亚组共纳入32篇中文文献,合计6272例患者进行Meta分析。结果显示,各试验组治愈率[OR=1.99,95%CI(1.78,2.23)],总有效率[OR=2.66,95%CI(2.20,3.22)],术后症状Ⅰ级改善率[OR=2.22,95%CI(1.60,3.06)],术后症状总改善率[OR=8.77,95%CI(1.09,70.64)],术腔清洁时间[OR=2.54,95%CI(1.70,3.79)],术腔上皮化时间[OR=–29.46,95%CI(–37.73,–21.18)],鼻腔纤毛运动速率(mucociliary transport rate,MTR)[OR=1.14,95%CI(0.22,2.06)]均优于对照组。安全性评价共纳入4篇文献进行Meta分析,结果显示试验组胃肠道反应与对照组相比差异无统计学意义[OR=0.25,95%CI(0.00,33.78)],而局部反应与对照组相比差异有统计学意义[OR=0.03,95%CI(0.01,0.12)]。结论在慢性鼻窦炎鼻内镜术后的治疗中,采用中药液冲洗治疗可提高临床疗效、加快愈合时间,不良反应发生率较小,但由于纳入试验方法学质量普遍较低,评价指标较完善的文献较少,尚需进一步开展设计科学、指标合理的随机对照试验。经过筛选,本课题组建议使用如下中药组成冲洗液:黄芩、薄荷、鱼腥草、金银花、辛夷、白芷、黄芪、当归、荆芥。
Objective To evaluate the efficacy and safety of traditional Chinese medicine（TCM） in treating Chronic Rhinosinusitis（CRS） after Functional Endoscopic Sinus Surgery（FESS）.Methods The following databases and periodicals such as PubMed（Jan.1980 to Jan.2009）,MEDLINE（1980 to 2009）,EBSCOhost（Jan.1975 to Jan.2009）,CALIS（1984 to 2009）,CNKI（1979 to 2007）,VIP（1989 to 2009）,CBM（1978 to 2009）;Chinese Journal of Otorhinolaryngology Head and Neck Surgery（1990 to 2008）,Journal of Clinical Otorhinolaryngology Head and Neck Surgery（1988 to 2008）,Otorhinolaryngology Head and Neck Surgery（1990 to 2008）,and Chinese Journal of Otorhinolaryngology of Integrated Traditional and Western Medicine（1996 to 2008） were searched by computer and handwork for randomized controlled trials（RCTs） about TCM to treat CRS after ESS.The trial screening,quality assessment,and the data extraction of the included trials were conducted before performing statistical analyses by using RevMan 4.2.10 software.Results A total of 32 RCTs in three sub-groups in Chinese literatures were identified with meta-analyses in comparisons of the cure rate（OR=1.99,95%CI 1.78 to 2.23）,total effective rate（OR=2.66,95%CI 2.20 to 3.22）,degree I postoperative improvement rate（OR=2.22,95%CI 1.60 to 3.06）,total postoperative improvement rate（OR=8.77,95%CI 1.09 to 70.64）,postoperative clean time（OR=2.54,95%CI 1.70 to 3.79）,postoperative epithelization time（OR= –29.46,95%CI –37.73 to –21.18）,and mucociliary transport rate（OR=1.14,95%CI 0.22 to 2.06）.A total of 4 RCTs were meta-analyzed to evaluate the safety in comparisons of gastrointestinal reaction（OR=0.25,95%CI 0.00 to 33.78） and local reaction（OR=0.03,95%CI 0.01 to 0.12）.Conclusion The current evidence shows TCM in treating CRS after ESS tends to improve the clinical efficacy and reduce the cure time without obvious adverse reaction.Due to the low methodological quality of included trials,more RCTs with high quality and large scale are required.
出处
《中国循证医学杂志》
CSCD
2011年第5期576-590,共15页
Chinese Journal of Evidence-based Medicine
基金
国家科技部"十一五"科技支撑计划课题(编号:2007BAI20B036)
关键词
慢性鼻窦炎
内镜治疗
中药
系统评价
Meta分析
随机对照试验
Chronic rhinosinusitis
Endoscope
Traditional Chinese medicine
Systematic review
Meta-analysis
Randomized controlled trial
