曲美他嗪联合麝香保心丸治疗慢性心力衰竭疗效的系统评价

目的：系统评价常规治疗基础上加用曲美他嗪联合麝香保心丸治疗慢性心功能不全的疗效。方法：系统检索CochraneLibrary、ProQuestResearchLibrary、MEDLINE、Embase、PEDro、OpenSIGLE、Na—tionalTechnicalInformationService（NTIS）、ScienceDirect、CNKI、VIP、WanfangData、CBM，文献检索日期截止于2013年4月30日。收集常规治疗基础上加用曲美他嗪联合麝香保心丸治疗慢性心功能不全的随机对照试验（RCT），按纳入和排除标准由2名评价者独立选择试验提取资料，交叉核对并进行方法学质量评估，对纳入研究的文献采用RevMan5．2软件进行Meta评价。结果：共纳入6项研究387例患者，Meta分析4个主要结局的结果显示：左心室射血分数（LVEF）改善方面、左室舒张末期内径（LVEDD）改善方面、左室收缩末期内径（LVESD）改善方面、6min步行距离改善方面的比较，其差异均有统计学意义。WMD（95％CI）分别为5．99（5．90，6．08）、-5．04（-5．90，-4．19）、-4．6（-8．59，-0．64）、42．73（32．48，52．97），均无不艮反应。4个主要结局的倒漏斗图显示左右不对称，提示可能存在发表性偏倚。结论：现有证据显示曲美他嗪联合麝香保心丸治疗慢性心力衰竭的疗效明显，左心室射血分数、左室舒张末期内径、6min步行距离、左室收缩末期内径的改善明显。受纳入文献质量的限制，其治疗慢性心力衰竭疗效的评价期待更多高质量的随机对照双盲研究，以进行进一步的评价。

A Systemic Evaluation on Trimetazidine Combined with Shexiang Baoxin Pill on Chronic Heart Failure

Objective： To review the therapeutical effect of trimetazidine and shexiang baoxin pill on chronic heart failure. Methods： The literature of randomized and controlled trialls （RCT） about treatment of chronic heart failure with trimetazidine and shexiang baoxin pill were retrieved from Coehrane Library, ProQuest Research Library, MEDLINE, Embase, PEDro, OpenSIGLE, NTIS, SeieneeDireet, CNKI, VIP, Wanfang Data and CBM （by Apt 30, 2013） , and then 2 reviewers inde- pendently chose RCT, extracted materials, checked crossly and gave methodological quality evalua- tion. Meta analysis was conducted by using Revman 5.2 software. Results ： A total of 6 trials and 387 patients were discovered. Meta analysis showed that at the end of the study, compared with routine remedy alone, the remedy of trimetazidine and shexiang baoxin pill on chronic heart failure obtained abvious amelioration on left ventricular ejection fraction （LVEF）, left ventrieular end diastolic diam- eter（LVEDD） , left ventrieular end shrink diameter（LVESD） and the walking distance of 6 min- utes, WMD （95% CI） ： 5.99 （5.90 to 6.08）, -5.04 （ -5.90 to -4.19）, -4.6 （ -8.59 to -0.64）, 42.73 （32.48 to 52.97）. There were not obvious adverse reactions. Conclusion： The existing evidence shows that the therapy of trimetazidine and shexiang baoxin pill is effective to chronic heart failure and can ameliorate left ventricular ejection fraction （LVEF） , left ventrieular end diastolic diameter （LVEDD） , left ventricular end shrink diameter（LVESD） and the walking distance of 6 minutes. As the limitation of the quality of enclosed literature, the review on the curative effect of chronic heart failure exDects more randomized controlled double-blind trials with high quality.