摘要
目的基于疾病负担,循证评价与遴选中国乡镇卫生院治疗脑血管供血不足的基本药物。方法应用本系列研究之二制定的循证评价与遴选标准、方法和流程,循证评价并推荐治疗脑血管供血不足的基本药物。结果①共纳入5个循证临床指南。②各国指南共涉及冠心病治疗药物5类13种。③阿司匹林被WHO EML(2011)、NEML(2009)、CNF(2010)共同推荐,指南证据较多,质量较高;肝素、对乙酰氨基酚、胰岛素、生理盐水、葡萄糖也均被3个目录推荐,但指南证据级别较低;华法林和氯吡格雷虽未被3个目录全部推荐,但指南证据级别较高;tPA重组纤溶酶原激活剂、GPⅡb/Ⅲa和抗生素在指南中不建议常规使用。④以上推荐药物国内均有相应剂型和规格上市,除氯吡格雷价格较高,其余药物价格可负担。⑤中文低质量证据表明阿司匹林、华法林、氯吡格雷疗效和安全性均较好,但结果与国外高质量证据存在差异,需进一步验证。结论①脑血管供血不足药物推荐:强推荐阿司匹林;弱推荐华法林、氯吡格雷、肝素、对乙酰氨基酚、胰岛素、生理盐水、葡萄糖;弱不推荐tPA重组纤溶酶原激活剂、GPⅡb/Ⅲa和抗生素。②国内脑血管供血不足药物治疗研究证据质量不高,缺少经济学评价研究。③建议对中医、中草药、特效药开展安全性、有效性和药物经济学评价研究,进行同类比较;加强脑血管疾病一、二级防治体系建设。
Objective To evaluate and select essential medicine for the treatment of cerebral circulation insufficiency by means of evidence-based approaches based on the burden of disease for township health centers located in the eastern,central and western regions of China.Methods By means of the approaches,criteria,and workflow set up in the second article of this series,we referred to the recommendations of evidence-based or authority guidelines from inside and outside China,collected relevant evidence from domestic clinical studies,and recommended essential medicine based on evidence-based evaluation.Data were analyzed by Review Manager（RevMan） 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.Results （1） Five clinical guidelines on transient ischaemic attack/ischaemic stroke were included,all of which were evidence-based clinical guidelines.（2） In total,there were 13 medicines（of five classes） listed in these guidelines.（3） We offer a strong recommendation for aspirin as essential medicine for cerebral circulation insufficiency and a weak recommendation for warfarin,clopidogrel,heparin,paracetamol,insulin,normal saline and glucose/dextrose.We made a recommendation against tPA,GPⅡ b/Ⅲ a and antibiotics according to WHOEML（2011）,NEML（2009）,CNF（2010）,other guidelines and the quantity and quality of evidence.（4） Recommended medicines have been marketed in China and their prices were affordable except Clopidogrel’s.（5） Some results of domestic low-quality studies indicated that recommend medicines were safe and effective,which had significant differences compared to high-quality evidence from foreign studies.Further studies were needed to be confirmed.Conclusion （1） We offer a strong recommendation for aspirin and a weak recommendation for warfarin,clopidogrel,heparin,paracetamol,insulin,normal saline and glucose/dextrose.We make a recommendation against tPA,GPⅡ b/Ⅲ a and antibiotics.（2） There is lack of high-quality evidence from relevant domestic studies,especially on long-term safety and pharmacoeconomic evidence.（3） We propose that more studies should be carried out on the safety,special efficacy and pharmacoeconomic of Chinese medicine,Chinese medicinals and medicine with special efficacy.Besides,we also compare recommended medicine with those of the same class and construct Level 1 to 2 systems of preventing and treating cerebral vascular diseases.
出处
《中国循证医学杂志》
CSCD
2012年第8期967-974,共8页
Chinese Journal of Evidence-based Medicine
基金
"十一五"国家科技支撑计划重点项目"不同类型乡镇卫生院科技综合示范及相关产品开发"--"乡镇卫生院药物配置与物流关键技术研究与产品开发"课题(编号:2008BAI65B22)
关键词
乡镇卫生院
基本药物
循证评价与遴选
脑血管供血不足
Township health center； Essential medicine； Evidence-based evaluation and selection； Cerebral circulation insufficiency；
