本文選題：血必凈 + 嚴重燒傷　； 參考：《廣西醫(yī)科大學》2013年碩士論文

【摘要】：背景：近年來國內(nèi)外對嚴重燒傷后應用血必凈治療的臨床報道較多,作為一種純中藥制劑,其臨床療效如何備受關注,目前關于血必凈在嚴重燒傷方面應用的臨床研究大多數(shù)為小樣本的隨機試驗,缺乏循證醫(yī)學方面的依據(jù)和說服力,故本文通過收納相關文獻進行Meta分析,旨在為血必凈在臨床上的使用提供參考。 目的：對血必凈在嚴重燒傷方面應用的臨床療效進行系統(tǒng)評價。 方法：應用計算機檢索中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM,1979/2013.3)、重慶維普中文科技期刊全文數(shù)據(jù)庫(VIP,1989/2013.3)、清華同方數(shù)據(jù)庫(CNKI,1979/2013.3)、萬方數(shù)據(jù)庫(1982/2013.3)、Pubmed、 EMBASE和Cochrane圖書館(1948-2013.3),以“血必凈”和“燒傷”為中文檢索詞,英文檢索詞包括"Xuebijing"和"Burn",并輔以手工檢索,收集血必凈對嚴重燒傷患者臨床治療的隨機對照試驗(RCTs),同時查閱納入文獻的參考文獻,以補充可能遺漏的研究,主要評價指標為(1)凝血酶原時間(PT)；(2)血液內(nèi)毒素水平；(3)炎癥因子白細胞介素-6(IL-6)、腫瘤壞死因子-a(TNF-a)水平和全身炎癥反應綜合征(SIRS)發(fā)生率；(4)反映心功能的肌酸激酶(CK)、肝功能的丙氨酸轉氨酶(ALT)及腎功能的肌酐(Cr)水平；(5)多器官功能衰竭綜合征(MODS)發(fā)生率。評價納入研究的方法學質量并進行資料提取后,對符合納入標準的文獻采用RevMan5.1軟件進行Meta分析,首先對納入研究進行異質性分析,經(jīng)檢驗無異質性的研究結果采用固定效應模型合并分析,存在異質性的則采用隨機效應模型合并分析。分析結果如果是連續(xù)變量采用均數(shù)差(mean difference, MD)或標準均數(shù)差(standard mean difference,SMD)表示,分類變量則采用相對危險度(relative risk, RR)表示,結果均給出95%可信區(qū)間(95%CI),發(fā)表偏倚采用漏斗圖顯示。 結果：共納入10個隨機對照試驗,包括532例嚴重燒傷患者。Meta分析結果顯示：與對照組比較,血必凈治療組患者的凝血酶原時間(PT)異常明顯改善(SMD=-1.35,95％CI=-1.95～-O.76,P0.00001)；治療后血液內(nèi)毒素水平與對照組相比降低(MD=-10.37,95％CI=-13.58～-7.16,P0.00001);與對照組比較,血必凈能減少炎癥因子IL-6和TNF-a的釋放,降低SIRS發(fā)生率,兩組差異均有統(tǒng)計學意義(IL-6:SMD=-O.82,95％CI=-1.28～-O.36,P=0.0005； TNF-a:SMD=-1.89,95％CI=-2.95～-0.82,P=0.0005；SIRS發(fā)生率：SMD=0.58,95％CI=0.45～0.75,P0.0001)；對心、肝及腎功能保護的方面,血必凈治療組均優(yōu)于對照組,統(tǒng)計學結果分別為(SMD=-0.35,95％CI=-O.64～-0.07,P=O.02).(SMD=-5.00,95％CI=-7.59～-2.41,P=0.0002).(SMD=-2.15,95％CI=-4.03～-0.27,P=0.03)；在減少MODS發(fā)生率方面,兩組差異無統(tǒng)計學意義(RR=0.58,95%CI=0.32-1.07,P-0.08)。 結論：上述結果表明嚴重燒傷后應用血必凈能有效保護患者的凝血功能,有助于清除血中的內(nèi)毒素和炎癥因子以減少它們對患者的全身性損害,并且對嚴重燒傷后患者的心、肝和腎功能具有良好的保護作用,但與常規(guī)治療組相比,血必凈治療組在降低MODS的發(fā)生率方面的作用尚不能得到有效的證據(jù)支持。由于本研究納入的原始文獻質量的局限性,有待于更多高質量研究的開展以進一步證實血必凈在嚴重燒傷方面的臨床療效。
[Abstract]:Background: in recent years, there are many clinical reports on the application of Xuebijing treatment after severe burns. As a pure Chinese medicine preparation, its clinical efficacy has been paid much attention. At present, most clinical studies on Xuebijing in severe burns are randomized trials of small samples, and lack of evidence and persuasion in evidence-based medicine. This article aims to provide reference for clinical application of Xuebijing by collecting relevant literature for Meta analysis.
Objective: to systematically evaluate the clinical efficacy of Xuebijing in the treatment of severe burns.
Methods: CBM, 1979/2013.3, VIP, 1989/2013.3, VIP, 1989/2013.3, CNKI, 1979/2013.3, 1982/2013.3, Pubmed, EMBASE and Cochrane Library (1948-2013.3), "Xuebijing" and "burn" were used by the computer. Chinese retrieval words, including "Xuebijing" and "Burn", combined with manual retrieval, collect the randomized controlled trial (RCTs) of Xuebijing's clinical treatment for severely burned patients, and refer to the references in the literature to supplement the possible missing studies. The main target is (1) the prothrombin time (PT); (2) the blood endotoxin water. (3) the incidence of inflammatory factor interleukin -6 (IL-6), tumor necrosis factor -a (TNF-a) and systemic inflammatory response syndrome (SIRS); (4) the cardiac function of creatine kinase (CK), alanine aminotransferase (ALT) and creatinine (Cr) level of liver function; (5) the incidence of multiple organ failure syndrome (MODS). After studying the quality of the methodology and extracting the data, the RevMan5.1 software is used for the Meta analysis of the documents which conform to the inclusion criteria. First, the heterogeneity analysis is carried out on the included research. The results of the study on the non heterogeneity are combined with the fixed effect model, and the heterogeneity is combined with the stochastic effect model. If mean difference, MD or standard mean difference, SMD) is used as a continuous variable, the relative risk degree (relative risk, RR) is used for the classification variables, and the results all give 95% confidence interval (95%CI), and the publication bias is displayed by the funnel graph.
Results: a total of 10 randomized controlled trials were included, including 532 cases of severe burn patients with.Meta analysis. Compared with the control group, the abnormality of prothrombin time (PT) in the patients with Xuebijing treatment group was significantly improved (SMD=-1.35,95%CI=-1.95 to -O.76, P0.00001), and the level of endotoxin in blood liquid was lower than that of the control group (MD=-10.37,95% CI=-13.58 ~ -7.16, P0.00001); compared with the control group, Xuebijing could reduce the release of inflammatory factors IL-6 and TNF-a, and reduce the incidence of SIRS (IL-6:SMD=-O.82,95%CI=-1.28 to -O.36, P=0.0005; TNF-a:SMD=-1.89,95%CI=-2.95 to -0.82, P= 0.0005); occurrence rate of 0.75. 0001); for the protection of heart, liver and kidney function, Xuebijing group was superior to the control group, and the statistical results were (SMD=-0.35,95%CI=-O.64 to -0.07, P=O.02). (SMD=-5.00,95%CI=-7.59 to -2.41, P=0.0002). (SMD=-2.15,95%CI=-4.03 to -0.27, P=0.03), and there was no statistical significance in reducing the incidence of MODS (RR=0.) (RR=0.). 58,95%CI=0.32-1.07, P-0.08).
Conclusion: the above results suggest that Xuebijing can effectively protect the patients' coagulation function after severe burns, help to remove endotoxin and inflammatory factors in blood to reduce their systemic damage to the patients, and have a good protective effect on the heart, liver and kidney function of patients after severe burns, but blood must be compared with the conventional treatment group. The role of the net treatment group in reducing the incidence of MODS has not yet been supported by effective evidence. Due to the limitations of the quality of the original literature included in this study, more high quality studies have been needed to further confirm the clinical efficacy of Xuebijing in severe burns.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R644

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