本文選題：參附注射液 + 低血壓�。� 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)中成藥參附注射液對(duì)低血壓患者血流動(dòng)力學(xué)影響,為應(yīng)用參附注射液防治低血壓提供循證醫(yī)學(xué)的證據(jù)。材料與方法:以“參附注射液”為主檢索詞聯(lián)合“低血壓”或“休克”或“泵衰”或“血流動(dòng)力學(xué)”或“厥脫”或“厥證”或“脫證”或“眩暈”分別進(jìn)行中文文獻(xiàn)全面檢索建庫(kù)至2016年12月在國(guó)內(nèi)各中文期刊發(fā)表的有關(guān)參附注射液防治低血壓的隨機(jī)對(duì)照試驗(yàn)的研究文獻(xiàn)。文獻(xiàn)納入標(biāo)準(zhǔn):(1)研究類(lèi)型:以參附注射液防治低血壓為主要研究目的的隨機(jī)對(duì)照實(shí)驗(yàn)。(2)研究對(duì)象:低血壓患者:收縮壓90mmHg、舒張壓60mmHg或原有基礎(chǔ)血壓降低30mmHg。(3)干預(yù)措施:實(shí)驗(yàn)組采用參附注射液,或參附注射液加上原有疾病的基礎(chǔ)治療,對(duì)照組采用西藥,或原有疾病的基礎(chǔ)治療(空白)作對(duì)照。(4)研究對(duì)象至少納入30位患者。(5)有研究指標(biāo)的原始數(shù)據(jù)。用Jadad評(píng)分量表對(duì)文獻(xiàn)的質(zhì)量進(jìn)行評(píng)分,用RevMan5.3統(tǒng)計(jì)軟件對(duì)納入研究進(jìn)行薈萃分析。結(jié)果:1.參附注射液組總有效率高于對(duì)照組,其差異具有統(tǒng)計(jì)學(xué)意義[OR=3.59,95%CI(2.56,5.05),總效應(yīng)Z=7.39,P0.00001]。2.參附注射液組患者收縮壓值高于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義[MD=14.74,95%CI(7.21,22.27),總效應(yīng)Z=3.84,P=0.00010.05],與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義[MD=0.82,95%CI(-8.78,10.42),總效應(yīng)Z=0.17,P=0.870.05]。3.參附注射液組患者舒張壓值高于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義[MD=9.45,95%CI(6.32,12.57),總效應(yīng)Z=5.93,P0.00001],與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義[MD=1.83,95%CI(-0.52,4.17),總效應(yīng)Z=1.53,P=0.130.05]。4.參附注射液組患者平均動(dòng)脈壓值高于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.00001),與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.210.05)。5.參附注射液組患者中心靜脈壓值高于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.00001),與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.05)。6.參附注射液組患者心率低于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義[MD=-12.14,95%CI(-15.81,-8.48),總效應(yīng)Z=6.49,P0.00001],與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義[MD=-3.67,95%CI(-37.98,30.63),總效應(yīng)Z=0.21,P=0.830.05]。7.參附注射液組患者尿量多于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.00001),與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.05)。8.參附注射液組患者左室射血分?jǐn)?shù)高于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.00001),與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.430.05)9.參附注射液組患者左室舒張末期內(nèi)徑小于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.00001),與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.540.05)。10.參附注射液組患者血管活性藥物使用量小于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.00001),與西藥組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.0001)。11.參附注射液組患者乳酸水平低于對(duì)照組,與空白組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P0.0001),與西藥組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.380.05)。12.參附注射液組患者心律失常發(fā)生率低于對(duì)照組,與空白組對(duì)比其差異不具有統(tǒng)計(jì)學(xué)意義(P=0.110.05),與西藥組對(duì)比其差異具有統(tǒng)計(jì)學(xué)意義(P=0.00050.05)。結(jié)論:參附注射液可以安全有效地提高低血壓患者血壓水平,包括收縮壓和舒張壓以及平均動(dòng)脈壓、中心靜脈壓,提高患者左室射血分?jǐn)?shù),增加患者尿量,同時(shí)可以降低患者心率、心律失常發(fā)生率、乳酸水平,減小左室舒張末期內(nèi)徑,但作用不優(yōu)于西藥;在血管活性藥物使用方面,參附注射液可以減少其用量且作用優(yōu)于西藥。
[Abstract]:Objective: To evaluate the hemodynamic effects of Shenfu Injection on hypotension in patients with hypotension and to provide evidence-based medicine for the application of Shenfu Injection in preventing hypotension. Materials and methods: "Shenfu Injection" was used as the main retrieval word combined with "hypotension" or "shock" or "pump failure" or "hemodynamics" or "syncope" or "syncope". A comprehensive retrieval of Chinese literature from Chinese literature to the Chinese Periodicals in December 2016 on the randomized controlled trials of Shenfu Injection on the prevention and treatment of hypotension in Chinese periodicals. The documents are included in the standard: (1) the study type: the randomised study of the main purpose of the study on the prevention and treatment of hypotension by the injection of annotation. Control experiment. (2) subjects: the patients with hypotension: systolic pressure 90mmHg, diastolic pressure 60mmHg or original basic blood pressure decrease 30mmHg. (3) intervention measures: the experimental group adopted Shenfu injection, or Shenfu Injection plus the basic treatment of the original disease, the control group used western medicine, or the basic treatment of the original disease (blank) as the control. (4) object to the study object to the control group. There were 30 patients. (5) the original data of the study index. The quality of the literature was scored by the Jadad scale, and the RevMan5.3 statistical software was used to carry out a meta-analysis on the inclusion study. Results: the total effective rate of the 1. Shenfu injection group was higher than the control group, the difference was statistically significant [OR=3.59,95%CI (2.56,5.05), the total effect Z=7.39, P0.00001 The systolic pressure of].2. Shenfu injection group was higher than that of the control group. Compared with the blank group, the difference was statistically significant [MD=14.74,95%CI (7.21,22.27), total effect Z=3.84, P=0.00010.05], compared with western medicine group, the difference was not statistically significant [MD=0.82,95%CI (-8.78,10.42), total effect Z=0.17, P=0.870.05].3. Shenfu injection group patients Shu. The difference of tension was higher than that of the control group, and the difference was statistically significant [MD=9.45,95%CI (6.32,12.57), the total effect was Z=5.93, P0.00001], and the difference was not statistically significant [MD=1.83,95%CI (-0.52,4.17), the total effect Z=1.53, and the average arterial pressure of the patients with P=0.130.05].4. Shenfu injection was higher than that of the control group, and the value of the total effect was higher than the control group, and the difference between the group and the empty group was higher than the control group. The difference of the white group was statistically significant (P0.00001). Compared with the western medicine group, the difference was not statistically significant (P=0.210.05) the central venous pressure of the patients in the.5. Shenfu injection group was higher than the control group, and the difference was statistically significant (P0.00001) compared with the blank group (P0.00001), and the difference was not statistically significant (P=0.05).6. compared with the western medicine group (P=0.05). The heart rate of the Shenfu injection group was lower than that of the control group. Compared with the blank group, the difference was statistically significant [MD=-12.14,95%CI (-15.81, -8.48), the total effect Z=6.49, P0.00001], compared with the western medicine group, the difference was not statistically significant [MD=-3.67,95%CI (-37.98,30.63), the total effect Z=0.21, and the patients in the P=0.830.05].7. Shenfu injection group had more urine volume than the control group. Compared with the control group, the difference was statistically significant (P0.00001). Compared with the western medicine group, the difference was not statistically significant (P=0.05) the left ventricular ejection fraction of the.8. Shenfu injection group was higher than that of the control group, and the difference was statistically significant (P0.00001) compared with the blank group (P0.00001), and the difference was not statistically significant compared with the western medicine group. (P=0.430.05) the left ventricular end diastolic diameter of the 9. Shenfu injection group was less than the control group. Compared with the blank group, the difference was statistically significant (P0.00001). The difference was not statistically significant (P=0.540.05) compared with the western medicine group (P=0.540.05) the use of vascular living drugs in the.10. Shenfu injection group was less than that of the control group, and the difference was compared with the blank group. Statistical significance (P0.00001), compared with the western medicine group, the difference was statistically significant (P0.0001).11. Shenfu injection group was lower than the control group, compared with the blank group, the difference was statistically significant (P0.0001), compared with the western medicine group, the difference was not statistically significant (P=0.380.05).12. Shenfu injection group patients heart. The incidence of arrhythmia was lower than that of the control group. Compared with the blank group, the difference was not statistically significant (P=0.110.05). Compared with the western medicine group, the difference was statistically significant (P=0.00050.05). Conclusion: Shenfu injection can improve the blood pressure level of the hypotension patients safely and effectively, including systolic and diastolic pressure, and the mean arterial pressure and central vein. Pressure, increase the left ventricular ejection fraction, increase the urine volume of patients, and reduce the heart rate, arrhythmia incidence, lactic acid level, reduce the left ventricular end diastolic diameter, but the effect is not better than western medicine; in the use of vasoactive drugs, Shenfu injection can reduce its dosage and effect better than Western medicine.

【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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