清热解毒、利咽消肿法治疗小儿急性化脓性扁桃体炎国内临床研究文献质量评价及临床疗效观察

发布时间：2018-06-28 03:50

本文选题：清热解毒 + 利咽消肿　；参考：《南京中医药大学》2013年硕士论文

【摘要】：目的：1评价清热解毒、利咽消肿法治疗小儿急性化脓性扁桃体炎国内临床研究文献的质量。2评价清热解毒、利咽消肿法联合西药治疗小儿急性化脓性扁桃体炎临床优势及可行性,为临床治疗小儿急性化脓性扁桃体炎提供有效的治疗方法及诊疗思路。方法：1通过计算机检索2000年1月—2012年12月国内公开发表的以清热解毒、利咽消肿法为主治疗小儿急性化脓性扁桃体炎的国内临床研究文献,按照纳入和排除标准进行筛选,对纳入的文献作质量评价。2收集60例确诊为急性化脓性扁桃体炎肺胃热盛证的患儿,随机分为治疗组、对照组各30例,对照组予头孢硫脒、喜炎平静滴治疗；治疗组予头孢硫脒、喜炎平静滴治疗并加用具有清热解毒、利咽消肿作用的中药汤剂口服,5天一个疗程,两组均辅以西医对症处理。结果：1检索到相关文献231篇,最终纳入评价的文献77篇。文献质量评价显示纳入研究文献的临床研究设计存在一系列问题。纳入文献经Meta分析显示,清热解毒,利咽消肿法治疗小儿急性化脓性扁桃体炎与西医治疗对比,异质性检验分析P=0.0030.10,所纳入文献存在异质性,采用随机效应模式,结果示：OR=2.84,95%CI为[1.54,5.24],合并效应量Z=3.34,P=0.00080.05,差异具有统计学意义。清热解毒,利咽消肿法联合西药治疗小儿急性化脓性扁桃体炎与西药治疗相比较,异质性检验分析P=1.000.10,所纳入文献不存在异质性,采用固定效应模式分析,结果示：0R=6.19,95%,CI为[4.99,7.68],合并效应量Z=16.56,P0.00001,提示清热解毒、利咽消肿法或清热解毒、利咽消肿法联合西药治疗小儿急性化脓性扁桃体炎与西药治疗相比总有效率更具有优势,治疗组优于对照组。2两组治疗前后在主要症状及次要症状方面改善情况组内比较,差异有统计学意义(P0.05)。治疗后两组组间比较,在改善主要症状方面,差异有统计学意义(P0.05)；在改善咳嗽、大便、发热、口渴等次要症状方面比较,差异有统计学意义(P0.05),治疗组优于对照组,在改善烦躁不安、舌象方面比较,治疗组与对照组无明显差异(P0.05)。两组治疗后主症积分、次症积分、总积分及综合疗效比较比较,差异有统计学意义(P0.05),治疗组优于对照组。结论：1对清热解毒、利咽消肿法或清热解毒、利咽消肿法联合西药治疗小儿急性化脓性扁桃体炎的临床随机对照试验文献进行质量评价,文献质量评价显示普遍较低,且在试验设计等方面存在问题,影响结论可靠性。Meta分析结果提示总有效率试验组较对照组确有优势。2临床研究显示清热解毒、利咽消肿法联合西药治疗小儿急性化脓性扁桃体炎是可行的,有效的方法,在改善咽痛、扁桃体肿大充血、扁桃体化脓、发热、咳嗽、口渴、大便等症状体征及综合疗效方面,治疗组均优于对照组。
[Abstract]:Objective to evaluate the quality of the domestic clinical research literature on the treatment of acute suppurative tonsillitis in children by the methods of removing heat and detoxifying toxin, and to evaluate the quality of the literature on clearing heat and detoxifying toxin. The clinical advantages and feasibility of the treatment of acute suppurative tonsillitis in children with Liyan Xiaoyong method combined with western medicine provide an effective treatment method and diagnosis and treatment thought for clinical treatment of acute suppurative tonsillitis in children. Methods from January 2000 to December 2012, the Chinese clinical literature on the treatment of acute suppurative tonsillitis in children was searched by using the method of clearing heat and detoxifying toxin and detoxifying the pharynx, and was screened according to the criteria of inclusion and exclusion. 60 children with acute suppurative tonsillitis were randomly divided into treatment group (n = 30) and control group (n = 30). The treatment group was treated with cefathiramidine, Heyan tranquil drop and combined with traditional Chinese medicine decoction with antipyretic and detoxifying effect, and the two groups were treated with western medicine for a period of 5 days. Results 231 related articles were retrieved by: 1 and 77 articles were included in the evaluation. Literature quality evaluation shows that there are a series of problems in clinical research design. Meta-analysis showed that the treatment of acute suppurative tonsillitis in children with antipyretic and detoxifying method was compared with that of western medicine, and heterogeneity test analysis (P < 0.0030.10) showed that there was heterogeneity in the literature, and the random effect model was used in the treatment of children with acute suppurative tonsillitis. The results showed that the CI was 1.54 / 5.24, and the combined effect was 0.00080.05. The difference was statistically significant. Compared with western medicine treatment of acute suppurative tonsillitis in children, Heterogeneity test was used to analyze the heterogeneity (P0.00.10), and there was no heterogeneity in the literature, so the fixed effect model was used. The results showed that the CI was [4.997.68], and the combined effect was ZH16.56 (P0.00001). The results indicated that the total effective rate of the treatment of acute suppurative tonsillitis in children was more effective than that of western medicine in the treatment of acute suppurative tonsillitis in children, such as clearing away heat and detoxifying toxin, detoxicating pharynx or clearing away heat and detoxifying toxin, and combining western medicine with Liyan's detumescence method in the treatment of acute suppurative tonsillitis in children. The treatment group was better than the control group before and after treatment in the main symptoms and secondary symptoms improvement in the group, the difference was statistically significant (P0.05). After treatment, the difference between the two groups in improving the main symptoms was statistically significant (P0.05); in improving cough, stool, fever, thirst and other secondary symptoms, the difference was statistically significant (P0.05), the treatment group was better than the control group, There was no significant difference between the treatment group and the control group in improving agitation and tongue image (P0.05). The difference between the two groups after treatment was statistically significant (P0.05), and the treatment group was superior to the control group. Conclusion the quality evaluation of the clinical randomized controlled trials on the treatment of acute suppurative tonsillitis in children with the methods of clearing heat and detoxification, detoxification of pharynx, detoxification of heat and swelling, combined with western medicine, showed that the quality evaluation of literature was generally low. The results of Meta-analysis showed that the total effective rate of the trial group was better than that of the control group. It is feasible and effective to treat acute suppurative tonsillitis in children with Liyan Xiaoyong method combined with western medicine. It is effective in improving symptoms, signs and comprehensive curative effects of pharynx, tonsil swelling and congestion, tonsil purulent, fever, cough, thirst, stool, etc. The treatment group was superior to the control group.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R272

【参考文献】