Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, China.
The Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120, China.
Chin J Integr Med. 2020 Jul;26(7):539-551. doi: 10.1007/s11655-019-3154-z. Epub 2019 Apr 10.
With increasing morbidity and mortality, acute myocardial infarction (AMI) has become one of the major causes of human death, leading to heavy burdens to individuals, families and society. Previous researches have found that though large amount of resources and great effort were devoted, no significant improvements were achieved in reducing the in-hospital mortality of AMI patients. Meanwhile, extensive studies about Chinese medicine (CM) have found that CM has special advantages in treating AMI patients. However, there is no standardized and unified clinical practice guideline (CPG) of CM for AMI. Therefore, a CPG with strict standard and generally acknowledgement is urgent to be established. This guideline was developed following the methodological process established by the World Health Organization Handbook for Guideline Development. Extensive search on clinical evidences including systematic review (SR), randomized controlled trial (RCT), observational study and case reports was launched, covering evidence of CM for AMI on several aspects, such as diagnosis, CM patterns, CM interventions on AMI and complications, cardiac rehabilitation and clinical pathway management. Besides, the application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach enabled the evaluation of evidence and formulation of grade of recommendation (GOR) and level of evidence (LOE). With the help of GOR and LOE, this CPG recommends the integrative CM and WM treatment method in AMI patients and provides useful information on medical decision for clinical physicians.
随着发病率和死亡率的不断上升，急性心肌梗死（AMI）已成为人类死亡的主要原因之一，给个人、家庭和社会带来了沉重的负担。既往研究发现，尽管投入了大量的资源和巨大的努力，但 AMI 患者住院死亡率并未显著降低。同时，大量关于中医药（CM）的研究发现，CM 在治疗 AMI 患者方面具有特殊优势。然而，目前尚无针对 AMI 的 CM 标准化和统一的临床实践指南（CPG）。因此，迫切需要制定具有严格标准和普遍认可的 CPG。本指南是按照世界卫生组织指南制定手册确立的方法学流程制定的。广泛搜索了包括系统评价（SR）、随机对照试验（RCT）、观察性研究和病例报告在内的临床证据，涵盖了 CM 在 AMI 的诊断、CM 证型、CM 对 AMI 及并发症的干预、心脏康复和临床路径管理等几个方面的证据。此外，采用推荐评估、制定与评价分级（GRADE）方法评估证据，并制定推荐等级（GOR）和证据水平（LOE）。本 CPG 借助 GOR 和 LOE，推荐了 AMI 患者的中西医结合治疗方法，并为临床医生的医疗决策提供了有用的信息。
