目的 系统评价 6 种清热解毒类中药注射液联合常规西医治疗儿童毛细支气管炎的疗效与安全性。方法 计算机检索中国期刊全文数据库 (CNKI)、万方数据库 (Wanfang)、维普数据库 (VIP)、CBM、Web of Science、The CochraneLibrary、PubMed 和 Embase 数据库收录的清热解毒类中药注射液治疗儿童毛细支气管炎的随机对照试验(RCT),检索时间均自建库至 2021 年 3 月 14 日。提取合格文献相关信息,通过 Cochrane 风险偏倚评价工具对纳入研究进行质量评价。使用 R软件、JAGS 软件和 GEMTC 软件包进行贝叶斯网状 Meta 分析。结果 最终纳入26项RCTs,涉及2 776例患儿及喜炎平注射液、炎琥宁注射液、血必净注射液、热毒宁注射液、痰热清注射液、鱼腥草注射液 6 种清热解毒类中药注射液。网状 Meta分析结果显示,与常规西医治疗相比,①提高临床总有效率方面,喜炎平注射液>炎琥宁注射液>血必净注射液>热毒宁注射液>痰热清注射液>鱼腥草注射液;②缩短憋喘时间方面,喜炎平注射液>痰热清注射液>热毒宁注射液>炎琥宁注射液>血必净注射液;③缩短咳嗽时间方面,热毒宁注射液>痰热清注射液>喜炎平注射液>血必净注射液;④肺部啰音消失方面,喜炎平注射液>鱼腥草注射液>热毒宁注射液>血必净注射液>炎琥宁注射液>痰热清注射液;⑤肺部哮鸣音消失方面,喜炎平注射液>热毒宁注射液>炎琥宁注射液>血必净注射液>痰热清注射液;⑥缩短平均住院时间方面,喜炎平注射液>炎琥宁注射液>热毒宁注射液>血必净注射液>鱼腥草注射液>痰热清注射液。6 种清热解毒类中药注射液在治疗过程中均未产生严重不良反应。结论 现有证据表明,清热解毒类中药注射液联合西医常规治疗可提高儿童毛细支气管炎的疗效,其中以喜炎平注射液总体治疗效果较好。

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

山东省中医药科技发展计划项目(2019-0298);山东省名老中医药专家司国民传承工作室项目(鲁卫函[2019]92)