| 514 | 8 | 85 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:系统评价中药治疗阻塞性睡眠呼吸暂停综合征(OSAS)的临床疗效和安全性。方法:计算机检索外文数据库:Cochrane Library、Pubmed、Embase以及中文数据库:中国学术期刊全文数据库(CNKI)、万方数据库(Wanfang)、维普数据库(VIP),以"中药"和"阻塞性睡眠呼吸暂停症"为关键词搜索,时间截止到2019年12月31日,搜索中药治疗OSAS临床随机对照试验(RCT),对纳入文献进行方法学质量评价,并采用Review Manage 5.3软件对纳入文献的结局指标进行Meta分析。结果:共纳入文献20篇,总例数1 297例。Meta分析结果显示,中药治疗组(汤剂或颗粒)在改善呼吸暂停低通气指数(AHI)均优于对照组[MD=-2.58,95%CI(-3.59,-1.56),P<0.000 01;MD=-5.47,95%CI(-6.75,-4.19),P<0.000 01];中药颗粒治疗组与对照组相比对最低夜间血氧饱和度(LSaO2)有明显改善作用[MD=2.76,95%CI(1.85,3.68),P<0.000 01]。中药治疗组(汤剂或颗粒)改善艾普沃斯睡眠量表(ESS)评分均优于对照组[MD=-1.50,95%CI(-2.13,-0.88),P<0.000 01;MD=-1.35,95%CI(-1.92,-0.78),P<0.000 01]。仅5例患者出现轻微不良反应,且未经特殊治疗症状消失。结论:中药治疗OSAS疗效明显,不良反应少,较为安全,然而纳入文献质量为中低水平,仍需高质量、样本量大的RCT研究加以证实。
Abstract：Objective: To systematically evaluate the clinical efficacy and safety of traditional Chinese medicine in the treatment of obstructive sleep apnea syndrome(OSAS). Methods: Foreign language databases were retrieved by computer: Cochrane Library, PubMed, EmBsae and Chinese databases: CNKI, Wanfang, VIP. The keywords such as "traditional Chinese medicine" and "obstructive sleep apnea" were searched until December 31, 2019. The randomized controlled clinical trial(RCT) of traditional Chinese medicine for OSAS was searched, and the quality of methodology was evaluated. Finally, the meta analysis of the outcome index was carried out by using review manage 5.3 software. Results: Totally 20 articles were included with 1 297 cases in total. The results of meta analysis showed that the Chinese medicine treatment group(decoction or granule) was superior to the control group in improving the apnea hypopnea index(AHI) [MD=-2.58, 95% CI(-3.59,-1.56), P<0.000 01; MD=-5.47, 95% CI(-6.75,-4.19), P<0.000 01]; the Chinese medicine granule treatment group was significantly better than the control group in improving the lowest night blood oxygen saturation(lsao2)(MD=2.76, 95% CI [1.85, 3.68], P<0.000 01). Chinese medicine treatment group(decoction or granule) improved the scores of Epworth Sleep Scale(ESS) better than the control group [MD=-1.50, 95% CI(-2.13,-.88), P<0.00001; MD=-1.35, 95% CI(-1.92,-0.78), P<0.000 01]. Only 5 patients had slight adverse reactions, and the symptoms disappeared without special treatment. Conclusion:Traditional Chinese medicine is effective and safe in the treatment of OSAS. However, the quality of the literature is low, which needs to be confirmed by RCT with large sample size.
1 Laratta CR,Ayas NT,Povitz M,et al.Diagnosis and treatment of obstructive sleep apnea in adults[J].CMAJ,2017,189:E1481- E1488.
2 Franklin KA,Lindberg E.Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea[J].J Thorac Dis,7:1311-1322.
3 杨秀荣.阻塞性睡眠呼吸暂停综合征治疗研究进展[J].医疗装备,2016,29(3):203-204.
4 Lim DC,Pack AI.Obstructive sleep apnea:Update and future[J].Annual Review of Medicine,2017,68(1):99-112.
5 Pinto VL,Sharma S.Continuous positive airway pressure (CPAP)[J].Stat Pearls[Internet],2019,11.
6 Shin W,Jen R,Li Y,et al.Tailored treatment strategies for obstructive sleep apnea[J].Espiratory Investigation,2016,54(1):2-7.
7 Qaseem,Amir.Management of obstructive sleep apnea in adults:A clinical practice guideline from the American college of physicians[J].Annals of Internal Medicine,2013,159(7):471-483.
8 Wang CC,Zhu R,Tan JY.The history of Chinese medicine and acupuncture.nurses and holistic modalities[J].Holistic Nursing Practice,2019,33(2):90-94.
9 Lv ZT,Jiang WX,Huang JM,et al.The clinical effect of acupuncture in the treatment of obstructive sleep apnea:A systematic review and meta-analysis of randomized controlled trials[J].Evid Based Complement Alternat Med,2016,2016:1-10.
10 范爱欣,庄娜,陆学超.中医药治疗阻塞性睡眠呼吸暂停综合征研究进展[J].亚太传统医药,2019,15(1):181-184.
11 王春娥,诸晶,严桂珍.中药治疗痰瘀互结型阻塞性睡眠呼吸暂停综合征的临床观察[J].医学研究杂志,2011,40(3):80-82.
12 诸晶.“鼾症一号方”治疗气虚痰瘀互结型阻塞性睡眠呼吸暂停低通气综合征的临床观察[D].福建中医药大学,2011.
13 冯炜,李文华,高峰,等.健脾化痰方治疗痰浊型阻塞性睡眠呼吸暂停低通气综合征60例[J].环球中医药,2015,8(11):1377-1379.
14 韦林强.祛瘀化痰法治疗阻塞性睡眠呼吸暂停低通气综合征20例观察[J].浙江中医杂志,2017,52(7):493.
15 徐婷贞,杨晓明.二陈解鼾颗粒对阻塞性睡眠呼吸暂停低通气综合征患者炎症因子的影响[J].浙江中医药大学学报,2018,42(10):98-102.
16 靳锐锋,崔红生,郭丰婷,等.消鼾利气颗粒治疗阻塞性睡眠呼吸暂停低通气综合征的临床疗效评价[J].中华中医药杂志,2019,34(1):376-378.
17 刘三峰.鼾症方对痰瘀互结型阻塞型睡眠呼吸暂停综合征的症状疗效分析[D].福建中医药大学,2018.
18 刘薇.六君子汤加味治疗阻塞型睡眠呼吸暂停低通气综合征57例临床研究[J].北京中医药,2006,25(7):387-389.
19 李鹏辉.半夏白术天麻汤加味治疗痰瘀阻窍型阻塞性睡眠呼吸暂停低通气综合征临床观察[D].河南中医药大学,2018.
20 许李娜.睡眠呼吸暂停综合征中医证侯规律的研究及鼾宁方对其的疗效观察[D].安徽中医药大学,2016.
21 李艳斐,王彬,高峰.化痰醒脾方治疗阻塞性睡眠呼吸暂停低通气综合征的疗效研究[C].中华中医药学会全国中医肺系病学术交流会暨青年委员会成立大会.2014.
22 陈沁,林劲榕,洪旭初,等.加味涤痰汤对老年阻塞性睡眠呼吸暂停低通气综合征患者氧化应激和炎性反应的干预作用[J].中华老年医学杂志,2015,34(7):715-719.
23 房芳,邓立伟,邓宏伟,等.加味半夏厚朴汤治疗痰气互结型阻塞性睡眠呼吸暂停低通气综合征的临床研究[J].世界中西医结合杂志,2018,13(12):1715-1718.
24 张晶.利咽散结药茶治疗OSAHS的临床研究[D].华北理工大学,2018.
25 李阳阳.升阳益胃汤加减治疗阻塞性睡眠呼吸暂停低通气综合征的临床疗效观察[D].长春中医药大学,2018.
26 王娟.血府逐瘀汤合温胆汤加减治疗阻塞性睡眠呼吸暂停低通气综合征(痰瘀互结证)的临床研究[D].成都中医药大学,2019.
27 王真,杨瑶超,沈莹莹,等.二陈解鼾颗粒治疗痰湿型阻塞性睡眠呼吸暂停低通气综合征的疗效观察[C].全国中西医结合防治呼吸系统疾病学术研讨会.2012.
28 李艳斐.健脾化痰方治疗阻塞性睡眠呼吸暂停低通气综合征的疗效研究[D].中国中医科学院,2014.
29 陈妍杰,郑承铎.从脾论治痰湿内阻型阻塞性睡眠呼吸暂停低通气综合征临床探析[J].海峡药学,2019,31(9):125-127.
30 Chen Q,Lin R,Hong X,et al.Treatment and prevention of inflammatory responses and oxidative stress in patients with obstructive sleep apnea hypopnea syndrome using Chinese herbal medicines[J].Experimental and Therapeutic Medicine,2016,12(3):1572-1578.
31 Cao MT,Sternbach JM,Guilleminault C.Continuous positive airway pressure therapy in obstuctive sleep apnea:benefits and alternatives[J].Expert Review of Respiratory Medicine,2017,11(4):259-272.
32 Weaver TE,Grunstein RR.Adherence to continuous positive airway pressure therapy:The challenge to effective treatment[J].Proc Am Thorac Soc,2008,5(2):173.
33 Noller MW,Guilleminault C,Gouveia CJ,et al.Mandibular advancement for adult obstructive sleep apnea:a systematic review and meta-analysis[J].J Craniomaxillofac Surg,2017,45(12):2035-2040.
34 Choi JH,Lee JY,Cha J,et al.Predictive models of objective oropharyngeal OSA surgery outcomes:success rate and AHI reduction ratio[J].PLoS One,2017,12(9):e0185201.
35 Tingting X,Danming Y,Xin C.Non-surgical treatment of obstructive sleep apnea syndrome[J].European Archives of Oto-Rhino-Laryngology,2017,275(2):335-346.
36 何权瀛,陈宝元.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)解读[J].中华结核和呼吸杂志,2012,35(1):7-8.
37 Chazal P,Sutherland K,Cistulli PA,Advanced polysomnographic analysis for OSA:A pathway to personalized management?Evid Based Complement Alternat Med[J].Respirology,2019,25(3).
38 Li SJ,Wang ZW.Etiology and pathogenesis of sleep apnea hypopnea syndrome[J].Tradit Chin Med Res,2018,31(12):8-11.
39 侯宁,于睿.从痰论治鼾症[J].中医临床研究,2019,11(12):74-76.
40 Gozal LK,Gozal D.Obstructive sleep apnea and inflammation:Proof of concept based on two illustrative cytokines[J].Int J Molecul Sci,2019,20(3):459.
基本信息:
DOI：10.13210/j.cnki.jhmu.20200716.001
中图分类号:R276.1
引用信息:
[1]包君丽,韩宇博,张可,等.中药治疗阻塞性睡眠呼吸暂停综合征随机对照试验的meta分析[J].海南医学院学报,2020,26(22):1717-1728.DOI:10.13210/j.cnki.jhmu.20200716.001.
基金信息:
国家自然科学基金(81873284); 黑龙江省博士后资助经费项目(LBH-Z18253); 黑龙江中医药大学校科研基金资助项目(2019TD01,2019BS02); 深圳市光明新区中医药科研项目(GM2019020017)~~
2020-07-17
2020-07-17
2020-07-17