目的 系統(tǒng)評價(jià) 6 種清熱解毒類中藥注射液聯(lián)合常規(guī)西醫(yī)治療兒童毛細(xì)支氣管炎的療效與安全性。方法 計(jì)算機(jī)檢索中國期刊全文數(shù)據(jù)庫 (CNKI)、萬方數(shù)據(jù)庫 (Wanfang)、維普數(shù)據(jù)庫 (VIP)、CBM、Web of Science、The CochraneLibrary、PubMed 和 Embase 數(shù)據(jù)庫收錄的清熱解毒類中藥注射液治療兒童毛細(xì)支氣管炎的隨機(jī)對照試驗(yàn)(RCT),檢索時(shí)間均自建庫至 2021 年 3 月 14 日。提取合格文獻(xiàn)相關(guān)信息,通過 Cochrane 風(fēng)險(xiǎn)偏倚評價(jià)工具對納入研究進(jìn)行質(zhì)量評價(jià)。使用 R軟件、JAGS 軟件和 GEMTC 軟件包進(jìn)行貝葉斯網(wǎng)狀 Meta 分析。結(jié)果 最終納入26項(xiàng)RCTs,涉及2 776例患兒及喜炎平注射液、炎琥寧注射液、血必凈注射液、熱毒寧注射液、痰熱清注射液、魚腥草注射液 6 種清熱解毒類中藥注射液。網(wǎng)狀 Meta分析結(jié)果顯示,與常規(guī)西醫(yī)治療相比,①提高臨床總有效率方面,喜炎平注射液>炎琥寧注射液>血必凈注射液>熱毒寧注射液>痰熱清注射液>魚腥草注射液;②縮短憋喘時(shí)間方面,喜炎平注射液>痰熱清注射液>熱毒寧注射液>炎琥寧注射液>血必凈注射液;③縮短咳嗽時(shí)間方面,熱毒寧注射液>痰熱清注射液>喜炎平注射液>血必凈注射液;④肺部啰音消失方面,喜炎平注射液>魚腥草注射液>熱毒寧注射液>血必凈注射液>炎琥寧注射液>痰熱清注射液;⑤肺部哮鳴音消失方面,喜炎平注射液>熱毒寧注射液>炎琥寧注射液>血必凈注射液>痰熱清注射液;⑥縮短平均住院時(shí)間方面,喜炎平注射液>炎琥寧注射液>熱毒寧注射液>血必凈注射液>魚腥草注射液>痰熱清注射液。6 種清熱解毒類中藥注射液在治療過程中均未產(chǎn)生嚴(yán)重不良反應(yīng)。結(jié)論 現(xiàn)有證據(jù)表明,清熱解毒類中藥注射液聯(lián)合西醫(yī)常規(guī)治療可提高兒童毛細(xì)支氣管炎的療效,其中以喜炎平注射液總體治療效果較好。

Objective To systematically evaluate the clinical effect and safety of six kinds of heat-clearing and detoxifying Chinese medicine injection in treatment of children with bronchiolitis. Methods Randomized controlled trial (RCT) on treatment of children with bronchiolitis by heat-clearing and detoxifying Chinese medicine injections were retrieved from eight databases including CNKI and PubMed (from establishment to March 14, 2021). Related information in eligible articles was extracted, and the quality of the included articles was assessed by Cochrane collaboration's tool for assessing risk of bias. R software, JAGS software and GEMTC software package was used for Bayesian network Meta-analysis. Results A total of 26 eligible studies were screened out, involving 2 776 patients and six kinds of heat-clearing and detoxifying Chinese medicine injection: Xiyanping Injection, Potassium Sodium Dehydroandrographolide Succinat Injection, Xuebijing Injection, Reduning Injection, Tanreqing Injection, Houttuynia Cordata Injection. According to the statistical difference and network Meta-analysis, compared with the treatment of conventional medicine alone, the injections are in the order of ① Xiyanping Injection>Potassium Sodium Dehydroandrographolide Succinat Injection> Xuebijing Injection>Reduning Injection>Tanreqing Injection>Houttuynia Cordata Injection in improving the clinical effective rate. ② Xiyanping Injection>Tanreqing Injection>Reduning Injection>Potassium Sodium Dehydroandrographolide Succinat Injection>Xuebijing Injection to the relief of wheezing. ③ Reduning Injection>Tanreqing Injection>Xiyanping Injection> Xuebijing Injection to the relief of cough. ④Xiyanping Injection>Houttuynia Cordata Injection>Reduning Injection>Xuebijing Injection>Potassium Sodium Dehydroandrographolide Succinat Injection>Tanreqing Injection to the relief of lung rale. ⑤Xiyanping Injection>Reduning Injection>Potassium Sodium Dehydroandrographolide Succinat Injection>Xuebijing Injection>Tanreqing Injection to relief of lung auscultation. ⑥ Xiyanping Injection>Potassium Sodium Dehydroandrographolide Succinat Injection> Reduning Injection>Xuebijing Injection>Houttuynia Cordata Injection>Tanreqing Injection in shortening mean hospital stay. In terms of safety, none of the six injections have serious adverse reactions. Conclusions The availabe evidence demonstrates that compared with western medicine treatment alone, heat-clearing and detoxifying Chinese medicine injection can effectively improve the effect of children bronchiolitis. Among them, Xiyanping Injection shows better effects.

R975

山東省中醫(yī)藥科技發(fā)展計(jì)劃項(xiàng)目(2019-0298);山東省名老中醫(yī)藥專家司國民傳承工作室項(xiàng)目(魯衛(wèi)函[2019]92)