| 引用本文:马媛虹1，2，李伟2，蒲琳倩2，张红2.中医外治法辅助治疗慢性心力衰竭的系统评价与Meta分析[J].世界中医药,2023,(02):. |
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| 中医外治法辅助治疗慢性心力衰竭的系统评价与Meta分析 |
| Systematic Evaluation and Meta-analysis of Adjuvant Treatment of Chronic Heart Failure with Traditional Chinese Medicine External Therapy |
| 投稿时间：2021-01-12 |
| DOI：10.3969/j.issn.1673-7202.2023.02.010 |
| 中文关键词: 慢性心力衰竭 中医外治法 随机对照试验 临床研究 辅助治疗 有效性 Meta分析 系统评价 |
| English Keywords:Chronic heart failure TCM external therapy Randomized controlled trials Clinical research Adjuvant treatment Effectiveness Meta-analysis System assessment |
| 基金项目:北京市中医药科技发展资金项目(JJ-2020-45) |
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| 中文摘要: |
| 目的:系统评价中医外治法辅助治疗慢性心力衰竭(CHF)的有效性和安全性。方法:检索PubMed,EMbase,The Cochrane Library,国家知识基础设施数据库(CNKI)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)。由2名研究者单独筛选文献、提取资料,应用RevMan5.3软件作Meta分析。结果:纳入26个临床研究,2 134例患者,观察组1 069例,对照组1 065例。Meta分析结果提示,与单纯常规西医治疗(或中药口服)比较,中医外治法联合常规西医治疗在总有效率(RR=1.25,95%CI为1.20~1.30,P<0.000 01)、左室射血分数(RR=3.73,95%CI为3.26~4.20,P<0.000 01)、左室舒张末期内径(RR=-3.09,95%CI为-3.46~-2.73,P<0.000 01)、左室收缩末期内径(RR=-2.30,95%CI为-2.56~-2.03,P<0.000 01)、N端原脑利尿钠肽(RR=-89.08,95%CI为-92.37~-85.79,P<0.000 01)、6 min步行试验(RR=42.46,95%CI为40.33~44.6,P<0.000 01)疗效更加显著;在明尼苏达生命质量评分(RR=-3.68,95%CI为-4.13~-3.22,P<0.000 01)、中医证候评分(RR=-3.78,95%CI为-3.94~-3.61,P<0.000 01)方面优于单纯常规西医治疗。中医外治法穴位贴敷治疗CHF整理数据方面,发现应用前5位的穴位是:心俞(90.9%)、膻中(72.7%)、内关(63.6%)、足三里(45.4%)、肺俞(27%)。结论:中医外治辅助治疗CHF,能提高治疗临床有效率;提高左室射血分数,增加左室舒张末期内径和收缩末期内径、6 min步行试验,降低N端原脑利尿钠肽;降低中医证候积分及明尼苏达生命质量评分;穴位贴敷使用的穴位:心俞、膻中、内关、足三里、肺俞。 |
| English Summary: |
| To systematically evaluate the effectiveness and safety of traditional Chinese medicine(TCM) external therapy in the treatment of chronic heart failure(CHF).Methods:This paper searched PubMed，EMbase，the Cochrane Library，China Biomedical Literature Database(CBM)，Chinese National Knowledge Infrastructure(CNKI)，China Science Periodical Database(CSPD)，and Chinese Citation Database(CCD).Two researchers individually screened out the literature，extracted the data，and used RevMan5.3 for Meta-analysis.Results:Twenty-six studies were included in the literature，with 2 134 patients，including 1 069 patients in the treatment group and 1 065 patients in the control group.The results of the Meta-analysis showed that the total effective rate of TCM external therapy combined with conventional western medicine was (RR=1.25，95%CI 1.20 to 1.30，P<0.000 01)，left ventricular ejection fraction was (RR=3.73，95%CI 3.26 to 4.20，P<0.000 01)，left ventricular end-diastolic diameter was(RR=-3.09，95%CI -3.46 to -2.73，P<0.000 01)，left ventricular end-systolic diameter was(RR=-2.30，95%CI -2.56 to -2.03，P<0.000 01)，NT-proBNP was(RR=-89.08，95%CI -92.37 to -85.79，P<0.000 01)，6-min walking test was(RR=42.46，95%CI 40.33 to 44.6，P<0.000 01)，and the curative effect was significantly better.The Minnesota Quality of Life Score was(RR=-3.68，95%CI -4.13 to -3.22，P<0.000 01)，and TCM syndrome score was(RR=-3.78，95%CI -3.94 to -3.61，P<0.000 01)，which was better than conventional western medicine alone.In terms of the data on the treatment of CHF with external acupoint application in TCM，the top five acupoints used were Xinshu(90.9%)，Tanzhong(72.7%)，Neiguan(63.6%)，Zusanli(45.4%)，and Feishu(27%).Conclusion:The treatment of CHF with TCM external therapy can improve the effective rate of treatment，left ventricular ejection fraction，left ventricular end-diastolic diameter，left ventricular end-systolic diameter，and 6-min walking test，and reduce NT-proBNP，TCM syndrome score，and Minnesota Quality of Life Score.At the same time，it is found that the first five acupoints used for acupoint application are Xinshu，Tanzhong，Neiguan，Zusanli，and Feishu. |
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