摘要
目的系统评价中西医结合治疗改善慢性心力衰竭患者血流动力学指标的有效性和安全性。方法检索建库2018年1月1日—2023年3月1日中国知网、万方、维普、PubMed、Cochrane Library、Embase中关于中西医结合治疗慢性心力衰竭血流动力学的临床研究,提取文献信息,建立数据库,总结文献中所有监测血流动力学方法及指标,运用Review Manager5.4.1软件meta分析。结果共纳入23篇文献,涉及患者2365例,试验组1186例,对照组1179例。Meta显示:主要结局指标中西医结合改善慢性心力衰竭患者血流动力学指标总有效率(RR=1.23,95%CI为1.19,1.28,P<0.0001),提示中西医结合改善慢性心力衰竭患者血流动力学指标优于单纯西医治疗,次要结局指标心输出量(RR=1.25,95%CI为1.18,1.32,P<0.001)、心脏指数(RR=1.25,95%CI为1.18,1.32,P<0.001)、外周阻力(RR=1.21,95%CI为1.14,1.28,P<0.001)、每搏量(RR=1.23,95%CI为1.15,1.32,P<0.0001)、心率(RR=1.25,95%CI为1.14,1.38,P<0.001)、外周血压(RR=1.28,95%CI为1.14,1.44,P<0.0001)、心脏收缩力指数(RR=1.18,95%CI为1.10,1.27,P<0.001)、左室射血分数(RR=1.26,95%CI为1.13,1.40,P<0.001)、胸液体容积(RR=1.25,95%CI为1.12,1.40,P<0.001)。血流动力学指标出现次数>3次的是:心输出量(47.8%)、心脏指数(47.8%)、外周阻力(43.5%)、每搏量(39.1%)、心率(26.1%)、外周血压(17.4%)、心脏收缩力指数(13.1%)、左室射血分数(13.1%)、胸液体容积(13.1%)。结论相比于单纯西医治疗,中西医结合治疗更能改善慢性心衰血流动力学,提高心输出量、心脏指数、每搏量、心脏收缩力指数、左室射血分数,降低外周血压、心率、外周阻力、胸液体容积。常应用血流动力学指标为心输出量、心脏指数、外周阻力、每搏量、心率、外周血压、心脏收缩力指数、左室射血分数、胸液体容积。
Objective To systematically evaluate the efficacy and safety of integrated traditional Chinese and western medicine in improving hemodynamic indexes in patients with chronic heart failure.Methods From January 1,2018 to March 1,2023,China National Knowledge Infrastructure(CNKI),Wanfang,VIP,PubMed,Cochrane Library and Embase were searched for clinical studies on hemodynamics of integrated traditional Chinese and Western medicine in the treatment of chronic heart failure,and literature information was extracted to establish a database.All monitoring hemodynamic methods and indicators in the literature were summarized,and meta-analysis was performed using Review Manager5.4.1 software.Results Meta analysis results:A total of 23 articles were included,involving 2365 patients,including 1186 patients in the experimental group and 1179 patients in the control group.Meta showed that the main outcome index was the total effective rate of hemodynamic indexes improved by integrated traditional Chinese and western medicine in patients with chronic heart failure(RR=1.23,95%CI:1.19,1.28,P<0.001),suggesting that the combination of traditional Chinese and western medicine improved the hemodynamic parameters of patients with chronic heart failure,and the secondary outcome was cardiac output(RR=1.25,95%CI:1.18,1.32,P<0.001),cardiac index(RR=1.25,95%CI:1.18,1.32,P<0.001),peripheral resistance(RR=1.21,95%CI:1.14,1.28,P<0.001),stroke volume(RR=1.23,95%CI:1.15,1.32,P<0.001),heart rate(RR=1.25,95%CI:1.14,1.38,P<0.001),peripheral blood pressure(RR=1.28,95%CI:1.14,1.44,P<0.001),cardiac contractility index(RR=1.18,95%CI:1.10,1.27,P<0.001),left ventricular ejection fraction(RR=1.26,95%CI:1.13,1.40,P<0.001),thoracic fluid volume(RR=1.25,95%CI:1.12,1.40,P<0.0001).Number of occurrences of hemodynamic indicators>The three times were cardiac output(47.8%),cardiac index(47.8%),peripheral resistance(43.5%),stroke volume(39.1%),heart rate(26.1%),peripheral blood pressure(17.4%),cardiac contractility index(13.1%),left ventricular ejection fraction(13.1%),and thoracic fluid volume(13.1%).Conclusion Compared with simple western medicine treatment,combined traditional Chinese and western medicine treatment can improve the hemodynamics of chronic heart failure,increase cardiac output,cardiac index,stroke volume,cardiac contractility index,left ventricular ejection fraction,and reduce peripheral blood pressure,heart rate,peripheral resistance,and thoracic fluid volume.Hemodynamic indices commonly used are cardiac output,cardiac index,peripheral resistance,stroke volume,heart rate,peripheral blood pressure,cardiac contractility index,left ventricular ejection fraction,and thoracic fluid volume.
作者
魏斌
杨莺
WEI Bin;YANG Ying(Liaoning University of Traditional Chinese Medicine,Shenyang 110847,Liaoning,China;Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning,China)
出处
《实用中医内科杂志》
2024年第11期85-90,I0023-I0028,共12页
Journal of Practical Traditional Chinese Internal Medicine
基金
辽宁省教育厅面上项目(LJKMZ20221343)。
关键词
中西医结合治疗
慢性心力衰竭
血流动力学
META分析
integrated traditional Chinese and western medicine treatment
chronic heart failure
hemodynamics
Meta analysis
作者简介
魏斌(1997-),男,辽宁海城人,硕士在读,研究方向:中西医结合防治心血管。;通讯作者:杨莺(1976-),女,辽宁沈阳人,主任医师,博士研究生导师,博士,研究方向:中西医结合防治心血管。E-mail:yy20170225@sina.com。
