中西药物结合治疗阿片类依赖急性戒断症状的有效性和安全性系统评价

目的:系统评价中西药物结合治疗阿片类依赖急性戒断症状的有效性与安全性。方法:通过计算机检索多种中英文数据库(PUBMED,EMBASE,CCRCT,CBM,CNKI,VIP以及万方数据库)得到1990年1月至2007年11月期间发表的中西药物结合疗法与单纯西药对比治疗阿片类依赖急性戒断症状的随机对照试验(RCT)。由2名系统评价员独立进行质量评价和资料提取,然后进行Meta分析。结果:根据纳入排除标准,最终共纳入7个随机对照试验(RCT),共597例受试者,其中海洛因依赖者477例。Meta分析结果显示,与单纯应用西药相比,中西药物结合组在治疗d9和d10的急性戒断症状评分显著低于单纯西药组,其加权均数差(WMD)及95%CIs为:-1·43-2·60,-0·26];-0·30-0·51,-0·09]。在疗程的其他时间点,两组急性戒断症状评分没有统计学差异。另外,中西药物结合组用药剂量较单纯西药组低,副作用较少。结论:根据现有数据,中西药物结合疗法是一种有效而安全治疗阿片类依赖急性戒断综合征的方法,但尚需更多高质量研究以增加证据的强度。

SYSTEMATIC REVIEW OF EFFECTIVENESS AND SAFETY OF CHINESE MEDICINE COMBINED WITH WESTERN MEDICINE IN TREATMENT OF OPIOID WITHDRAWAL SYNDROME

Objective:To assess the effectiveness and safety of Chinese medicine combined with western medicine in the treatment of opioid withdrawal symptoms. Methods:Both English databases (EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials) and Chinese databases (Chinese Biomedical Literatures, China National Knowledge Infrastructure, Wan Fang, and VIP)were searched, and all reports of relevant clinical trials published from January 1990 to November 2007 were located. Randomized controlled trails (RCTs) of Chinese medicine combined with western medicine in the treatment of opioid detoxification were recruited. Two reviewers reviewed the search hits and assessed the methodological quality independently, and uncertainties were resolved through discussion. Results:Seven RCTs (with 597 patients including 477 heroin dependent patients) were included for Meta-analysis. Combined therapy group scored significantly less than western medicine group in controlling opioid withdrawal symptoms on d9 and d10. WMD and 95% CIs of these two days were:-1.43\-2.60, -0.26\]; -0.30\-0.51, -0.09\]. No significant difference was found during other days of treatment. Combined therapy decreased the dosage of medicine used and showed fewer side effects. Conclusion:Based on current evidence, Chinese medicine combined with western medicine is an effective and safe treatment for opioid detoxification. Well-designed randomized controlled trials are needed.