中药联合西药治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效及安全性：系统评价和荟萃分析研究。
The efficacy and safety of combined traditional Chinese and western medicine in the treatment of chronic obstructive pulmonary disease complicated with respiratory failure: a systematic review and meta-analysis study.
机构信息
Integrated TCM & Western Medicine Department, The First People's Hospital of Wenling (The Affiliated Wenling Hospital of Wenzhou Medical University), Wenzhou, China.
Department of the Traditional Chinese Medicine, The First People's Hospital of Wenling (The Affiliated Wenling Hospital of Wenzhou Medical University), Wenzhou, China.
出版信息
Ann Palliat Med. 2022 Mar;11(3):1102-1111. doi: 10.21037/apm-22-272.
BACKGROUND
The conventional drugs to treat chronic obstructive pulmonary disease (COPD) complicated with respiratory failure (RF) (COPD + RF) in western medicine include antibiotics, etc., but the patients have serious adverse reactions and are prone to drug resistance. This study aims to analyze the curative effect of traditional Chinese medicine (TCM) combined with Western medicine (WM) in treating COPD + RF.
METHODS
Randomized controlled studies on the treatment of COPD with RF were searched in PubMed, Web of Science, Embase, and The Cochrane Library. Outcome measures were treatment efficiency, oxygen partial pressure (PO2), partial pressure of carbon dioxide (PCO2), and pulmonary function [forced expiratory volume in 1 second (FEV1)%]. The Cochrane Reviewer's Handbook 4.2.5 was adopted for quality assessment of studies, and the data was analyzed using RevMan 5.3.
RESULTS
Seven suitable articles were selected, including 490 patients. The literature quality met the requirements of this article, and there was no obvious publication bias. The effective rate of patients in the combined TCM and WM treatment group and control group (WM treatment) was analyzed as odds ratio (OR) [95% confidence interval (CI): 5.40 (3.14 to 9.29)], and statistically tested as Z=6.09 (P<0.00001). The analysis structure of PO2 after treatment was mean difference (MD) (95% CI): 5.92 (2.27 to 9.56), and the statistical analysis suggested Z=3.18, P=0.001. The analysis of PCO2 after treatment was MD (95% CI): -4.53 (-7.14 to -1.92), and Z=3.40, P=0.0007. The analysis structure of lung function index data was MD (95% CI): 8.16 (2.57 to 13.75), and Z=2.86 (P=0.004).
DISCUSSION
The TCM combined with WM can effectively treat the symptoms related to COPD; the treatment efficiency is significantly improved compared with traditional WM; and the PO2, PCO2, and lung function (FEV1%) are improved for sure after treatment. Data of this study show that the combined treatment of TCM and WM has a good therapeutic effect on the acute exacerbation of COPD complicated with RF, which is worthy of clinical application. However, the included outcome indexes in this study were not sufficient, and the sample size and outcome indexes should be further expanded in the future.
背景
西医治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭（RF）（COPD + RF）的常规药物包括抗生素等，但患者不良反应严重，易产生耐药性。本研究旨在分析中药（TCM）联合西药（WM）治疗 COPD + RF 的疗效。
方法
在 PubMed、Web of Science、Embase 和 The Cochrane Library 中检索 WM 治疗 COPD + RF 的随机对照研究。观察指标为治疗有效率、氧分压（PO2）、二氧化碳分压（PCO2）和肺功能[第 1 秒用力呼气量（FEV1）%]。采用 Cochrane 评价员手册 4.2.5 对研究质量进行评估，采用 RevMan 5.3 进行数据分析。
结果
共纳入 7 篇符合条件的文献，共 490 例患者。文献质量符合本文要求，无明显发表偏倚。联合 TCM 和 WM 治疗组和 WM 对照组（WM 治疗）患者的有效率采用比值比（OR）[95%置信区间（CI）：5.40（3.14 至 9.29）]分析，经 Z 检验，差异有统计学意义（Z=6.09，P<0.00001）。治疗后 PO2 分析结构为均数差（MD）（95%CI）：5.92（2.27 至 9.56），统计分析表明 Z=3.18，P=0.001。治疗后 PCO2 分析结构为 MD（95%CI）：-4.53（-7.14 至 -1.92），Z=3.40，P=0.0007。肺功能指标数据分析结构为 MD（95%CI）：8.16（2.57 至 13.75），Z=2.86（P=0.004）。
讨论
TCM 联合 WM 可有效治疗 COPD 相关症状；与传统 WM 相比，治疗有效率明显提高；治疗后 PO2、PCO2 和肺功能（FEV1%）肯定会改善。本研究的数据表明，TCM 联合 WM 对 COPD 合并 RF 急性加重具有良好的治疗效果，值得临床应用。但是，本研究纳入的结局指标不够充分，未来应进一步扩大样本量和结局指标。
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