中医综合疗法治疗急性缺血性中风病的系统评价
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摘要
目的:系统评价中医综合疗法治疗急性缺血性中风病的临床疗效,筛选优势疗法,并找出目前中医药临床研究存在的问题,提出解决方法,为临床决策或者为未来的研究决策提供依据,提高中医药临床研究质量和水平。方法:探讨中医综合疗法治疗缺血性中风病的理论根据;全面收集中医药治疗急性缺血性中风病的临床试验,制定选择标准,筛选合格研究,采用Jadad评分标准评价合格研究质量,定性、定量分析各种中医综合疗法对急性缺血性中风病的临床疗效。结果:检索中医药治疗急性缺血性中风病相关文献2万余篇,纳入合格研究40项,涉及中医综合疗法(即试验措施)有18种组合方式,即使同一中医综合疗法组合方式,但其具体用药或针灸、推拿选穴或方法等也各不相同,或同一组合的中医综合疗法,其疗效判定指标又不尽相同。统计分析总有效率的相对危险度、神经功能缺损积分和(或)日常生活能力评分的加权均数差,并计算其99%可信区间。结论:本研究显示中医综合疗法治疗急性缺血性中风病有临床意义。通过总有效率的RR值比较,其优势疗法为口服或鼻饲化瘀通络汤药+头、体针刺(头针施于病灶侧运动区、感觉区、足运感区、语言区,体针取阳明经穴为主);通过神经功能缺损评分或NIHSS积分的WMD的比较,其优势疗法为口服或鼻饲化痰清热、祛瘀通络汤药+活血祛瘀针剂+头、体针刺(中脏腑闭证十宣、十井、耳尖放血,另刺人中、内关;中脏腑脱证灸关元、神厥、涌泉、百会及刺人中;中经络刺阳明经穴为主;配选头针运动区);通过日常生活能力积分的WMD的比较,其优势疗法为口服或鼻饲益气醒神、祛瘀涤痰免煎颗粒+散寒除湿活络针剂+口服补血活血、行气化痰通络中药丸剂;另通过本研究发现中医临床研究存在许多问题,如研究文献质量普遍较低;诊断、治疗、疗效评价体系的临床异质性较大等,亟需解决和提高。
Objective:To assess the effectiveness of the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy systematically,filtrate advantageous therapeautic methods,and find some problems of many clinical researches of TCM, then put forward some solutions to the problems and some principles for policy-making of clinical researches in future and in order to increase the qualities and standards of clinical researches of TCM.Methods: Inquired into the theoretical foundation of the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy.Collected clinical experiments of TCM in acute ischemic apoplexy fully, established a choice criterion ,filtrated qualified researches,evaluating the quality of the qualified researches by using the Jadad standard of perfection,analyse the clinical effectiveness indexes of all kinds of qualified the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy qualitatively and quantitatively.Results: Retrieve more than 20 thousand related documents, 40 items were brought into the qualified researches, there were 18 forms of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy, there were different kinds of herbs or chosen points or methods of acupuncture or Tuina even if the same form of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy, and there were different effectiveness standards used in the qualified researches even through the same kind of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy.Made stastical analyses to relative risk of the overall effective rate, weighted mean difference of nerve function deficiency grade and grade of the ability of activities of daily living, calculated their 99% confidence intervals.Conclusion: Through the research,we made the conclusion that the therapeautic methods of the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy had clinical curative effect; in accordance with the comparative outcome of RRs of total effective rate successively,the advantageous therapeutic methods of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy were taking or nasal feeding decoction of resolving blood stasis and making collaterals through + scalp plus body acupuncture (scalp acupuncture in motor area, sensory area, foot motor sensory area, speech area of the focus side, and body acupuncture on yangming meridian acupoints); according to the comparative outcome of WMDs of neurologic impairment or NIHSS, the advantageous therapeutic methods of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy were taking or nasal feeding decoction of resolving phlegm, clearing heat,removing blood stasis and making collaterals through+injection of promoting blood circulation and removing blood stasis+scalp plus body acupuncture(bleeding on shixuan,shijing and erjian, puncturing points of renzhong and neiguan if loss of spirit caused by sthenia syndrome;moxibustion guanyuan, shenque, yongquan,baihui, and puncturing renzhong if loss of spirit caused by asthenia syndrome; puncturing yangming meridian acupoints; scalp acupuncture in motor area); according to the comparative outcome of WMDs of Bathel indices of ability of daily life, the advantageous therapeutic methods of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy were taking or nasal feeding herbal granules free of decoction of benefiting qi,awakening shen, removing blood stasis and dispelling phlegm+ injection of eliminating cold,dispelling dampness and making collaterals through+taking herbal pills of supplementing blood,making blood circulation,making qi flowing,dispelling phlegm and making collaterals through;Moreover,we found a lot of problems in clinical researches of TCM, such as the poor qualities of the clinical researches documents,the different standards of diagnoses,therapies and effect,and so on.It is almost urgent to solve these problems.
Objective:To assess the effectiveness of the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy systematically,filtrate advantageous therapeautic methods,and find some problems of many clinical researches of TCM, then put forward some solutions to the problems and some principles for policy-making of clinical researches in future and in order to increase the qualities and standards of clinical researches of TCM.Methods: Inquired into the theoretical foundation of the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy.Collected clinical experiments of TCM in acute ischemic apoplexy fully, established a choice criterion ,filtrated qualified researches,evaluating the quality of the qualified researches by using the Jadad standard of perfection,analyse the clinical effectiveness indexes of all kinds of qualified the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy qualitatively and quantitatively.Results: Retrieve more than 20 thousand related documents, 40 items were brought into the qualified researches, there were 18 forms of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy, there were different kinds of herbs or chosen points or methods of acupuncture or Tuina even if the same form of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy, and there were different effectiveness standards used in the qualified researches even through the same kind of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy.Made stastical analyses to relative risk of the overall effective rate, weighted mean difference of nerve function deficiency grade and grade of the ability of activities of daily living, calculated their 99% confidence intervals.Conclusion: Through the research,we made the conclusion that the therapeautic methods of the Comprehensive Treatment of TCM on Acute Ischemic Apoplexy had clinical curative effect; in accordance with the comparative outcome of RRs of total effective rate successively,the advantageous therapeutic methods of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy were taking or nasal feeding decoction of resolving blood stasis and making collaterals through + scalp plus body acupuncture (scalp acupuncture in motor area, sensory area, foot motor sensory area, speech area of the focus side, and body acupuncture on yangming meridian acupoints); according to the comparative outcome of WMDs of neurologic impairment or NIHSS, the advantageous therapeutic methods of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy were taking or nasal feeding decoction of resolving phlegm, clearing heat,removing blood stasis and making collaterals through+injection of promoting blood circulation and removing blood stasis+scalp plus body acupuncture(bleeding on shixuan,shijing and erjian, puncturing points of renzhong and neiguan if loss of spirit caused by sthenia syndrome;moxibustion guanyuan, shenque, yongquan,baihui, and puncturing renzhong if loss of spirit caused by asthenia syndrome; puncturing yangming meridian acupoints; scalp acupuncture in motor area); according to the comparative outcome of WMDs of Bathel indices of ability of daily life, the advantageous therapeutic methods of Comprehensive Treatment of TCM on Acute Ischemic Apoplexy were taking or nasal feeding herbal granules free of decoction of benefiting qi,awakening shen, removing blood stasis and dispelling phlegm+ injection of eliminating cold,dispelling dampness and making collaterals through+taking herbal pills of supplementing blood,making blood circulation,making qi flowing,dispelling phlegm and making collaterals through;Moreover,we found a lot of problems in clinical researches of TCM, such as the poor qualities of the clinical researches documents,the different standards of diagnoses,therapies and effect,and so on.It is almost urgent to solve these problems.
引文
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