不同水蛭制剂治疗急性期缺血性脑卒中临床疗效比较

目的：系统评价并比较各种单复方水蛭制剂治疗急性期缺血性脑卒中的临床疗效。方法：检索各种单复方水蛭制剂治疗急性期缺血性脑卒中随机对照试验文献，筛选合格研究，应用Jadad评分法进行质量评价，运用异质性检验、Meta-分析、敏感性分析等方法统计比较相关数据。结果：25项研究被分别纳入7种药物的系统评价，Jadad评分所有研究得分均低于3分，属低质量文献。纳入研究共涉及疏血通注射液、通心络胶囊、单味水蛭制剂、脑心通胶囊、血栓心脉宁胶囊等7种单复方水蛭制剂，上述水蛭制剂相关研究分别采用临床总有效率、神经功能缺损评分、日常活动能力评分中的1项或几项指标进行了疗效比较。结论：系统评价的证据显示，对于急性期缺血性脑卒中患者，疏血通注射液在提高临床疗效、改善神经功能缺损状况、提高日常活动能力方面均显示出较好的治疗作用。要进一步验证单复方水蛭制剂治疗急性期缺血性脑卒中的疗效，尚需进行设计合理、执行严格、多中心大样本且随访时间足够的随机对照试验。

Comparing the curative effect of different hlrudo preparations for acute ischaemic stroke

Objective:To systematicly review and compare the clinical curative effect of all kinds of hirudo preparations for acute ischaemic stroke. Methods:Randomized controlled trails (RCTs) of different hirudo preparations for acute ischaemic stroke were identified, eligible studies were included, the methodological quality of inclusive trails was assessed by Jadad scale. Heterogeneity test, Meta-analysis and sensitivity analysis were used to analyse data. Results:Twenty-five RCTs with all trails of low methodological quality were brought into seven systematic reviews.Seven hirudo preparations were included. Clinical curative effect was appraised by overall effective rate, neurological impairment scale and activity daily living scale. Conclusion:The evidence of systematic reviews showed shuxuetong injection was effective and safety in advancing clinical curative effect, improving neurological impairment and activity daily living for acute ischaemic stroke. However, the evidence is not strong due to the general low methodological quality. To determinately evaluate efficacy and safety of hirudo preparations for acute ischaemic stroke, more rationally designed and strictly executed RCTs with large samples are necessary.