氨溴索不同给药途径治疗小儿下呼吸道感染的Meta分析

目的 评价盐酸氨溴索注射液不同给药途径辅助治疗小儿下呼吸道感染的疗效.方法 系统检索中国生物医学文献数据库(CaM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)和万方数据库,对纳入不同给药途径的盐酸氨溴索进行随机对照试验,并对纳入文献进行质量评价,应用RevMan5.0软件进行Meta分析,结果共纳入10篇报道,所有文献质量均为C级.共收入受试者1 244例,其中静脉滴注组575例,吸入给药组487例,联合给药组(静脉滴注+吸入)182例.Meta分析结果显示:1)吸入和静脉滴注比较:总有效率RR=1.06,95%CI(0.98,1.16)]、肺部罗音消失时间(MD=-0.40,95%CI(-1.27,0.46)]和平均住院日MD=-0.20,95%CI(-0.50,0.10)]的差异均无统计学意义;2)吸入和联合比较:总有效率RR=0.90,95%CI(0.83,0.97)]、肺部罗音消失时间MD=0.73,95%CI(0.08,1.38)]和平均住院日MD=0.63,95%CI(0.26,1.00)]的差异均有统计学意义;3)静脉滴注和联合比较:总有效率RR=0.90,95%CI(0.84,0.97)]、肺部罗音消失时间MD=0.76,95%CI(0.21,1.31)]和平均住院MD=1.10,95%CI(0.25,1.95)的差异均有统计学意义.结论 根据当前国内证据,对于小儿下呼吸道感染辅助治疗,氨溴索吸入和静脉滴注给药疗效相当,且从雾化吸入注射液的安全性和用药合理性考虑,不推荐选用氨溴索注射液雾化吸入给药.

Meta Analysis of Different Administration Pathways of Ambroxol for Treating Lower Respi- ratory Tract Infections in Children

Objective To evaluate the therapeutic efficacy of adjunctive therapy of ambroxol hydrochloride injection by different adminis- tration pathways for treating lower respiratory tract infections in children. Methods The randomized controlled trials （RCTs） of Ambrox- ol Hydroehloride Injection with different administration pathways were included by systematically retrieving the literatures of CBM,CNKI, VIP and Wanfang database. The quality of included literatures was evaluated and the meta analysis was performed by RevMan 5.0 soft- ware. Results A total of 10 RCTs were included and the quality of all literatures was the grade C. Among the included 1 244 cases, 575 cases were included in the intravenous group, 487 cases in the inhalation group and 182 cases in the combination group （intravenous ＋ inhalation）.The meta analysis indicated： （1） comparison of inhalation and intravenous drip： the total effective rate RR=1.06,95% CI （0.98, 1.16）],pulmonary rales disappearing time MD=-0.40,95% C1 （-1.27,0.46）] and the average hospitalization day I MD =-0.20, 95% CI （-0. 50, 0. 10）] had no statistical difference; （2） comparison of inhalation and combi- nation：the total effective rate RR=0.90,95% CI（0. 83, 0. 97） ] , pulmonary rales disappearing time MD=0.73,95%CI （0.08, 1.38）] and the average hospitalization day MD =0. 63,95% CI（0. 26, 1.00）] had statistical difference; （3） comparison of intravenous drip and combination：the total effective rate RR=0.90,95% CI （0.84,0.97）],pulmonary rales disappearing time MD=0.76,95% CI （0.21,1.31）] and the average hospitalization day MD=1.10,95% CI（0.25,1.95）] had statistical difference. Conclusion Based on the current domestic evidence, inhalation and intravenous drip of arnbroxol have the same effectiveness in the adjunctive therapy for treating lower respiratory tract infection in children. Considering the safety of atomization inhalation and the rationality of medication,am- broxol injection is not recommended for atomization inhalation.