| In recent decades, there is magnitude development in the therapy of acute myocardial infarction (AMI). New therapies are developed, such as thrombolysis, percutaneous tranluminal coronary angioplasty (PTCA), stent implantation, angiotensin-converting enzyme inhibitor (ACEI), β - receptor blocker, antiplatelet drug, and so on. Compelling evidences are afforded by large scale clinical trials following the principle of Evidence Based Medicine (EBM) to support all these therapies. Due to the use of these new therapies, the mortality and morbidity of AMI are reduced to 4%~6%, the long-term prognosis is also improved but still need further improvements.There is a long-years history of clinical studies on the treatment of AMI by Traditional Chinese Medicine (TCM) and Integrated Traditional and Western Medicine (ITWM). These studies had been pay great attentions to before reperfusion therapy was used, and had been well studied. It showed that the use of Integrated Traditional and Western Medicine have some advantage on preventing and curing the complication of AMI, and reducing the mortality in some way. But the quality and effectiveness of all these studies have not been systematically reviewed yet. Because of the neglect in methodology of clinical study, there is no evidence following the principle of EBM in the results of clinical studies of TCM. It limits the use and popularization of TCM in a certain extent.In this thesis, a systematic review of clinical studies on the treatment of AMI by TCM in these decades will be performed, and a retrospective cohort study with fairly large sample will be designed to approach the benefit of Chinese herb on long-term prognosis of AMI. The aim of this thesis is try to provide evidence of ITWM for AMI based on EBM.1. Chinese medicine herb for acute myocardial infarction: a systematic review and meta analysisMethods: (1)Search items were (Title: myocardial infarction) AND (All field: Chinese medicine OR Chinese herb OR Integrated Trasitional and Western Medicine), the search was applied to the CBM database (1978.1-2004.11). (2)Literature bolting was performed by 2 reviewers independently according to the standard of in and out, different opinions should be solved through negotiation. (3)The relation data of literature were extracted and evaluated. (4) A meta analysis was performed based on qualified literatures.Result: (1) 1621 literatures were found out. (2)Through twice blotting, there were 252 clinical study literatures meet the evaluate procedure. (3)According to the principle of modern clinical epidemiology, there were many questions of the clinical study on the treatment of AMI by TCM. The first question was lack of standards, including diagnosis and effectiveness standard. The second, there were many obviously defects on the designation, especially in randomization, blinding and statistics method. The third, the choice of observed index was not perfect, lacked of long-term indexes. The literatures mentioned about "randomize" wereevaluated according to Jadad score, only 1 study get 3 score (total score was 5). The evaluation of non-randomized controlled trial was also unsatisfactory, no studies get 50% score. (4)Only 8 literatures came into meta analysis (758 cases), the result of analysis showed that compared with basic Western Medicine drug, additional use of Chinese herb could not reduce mortality (P=0.24) or arrhythmia (P=0.07), could not raise total clinical effective rate (P=0.17), but reduced re-infarction (P=0.007) and heart failure (P=0.01), improved left ventricular ejection fraction (P<0.0001).Conclusion: There are many questions of clinical study on the treatment of AMI by TCM, which weaken the reliability of these studies. Meta analysis shows that Chinese herb has some benefits in reducing re-infarction and heart failure, raising left ventricular ejection fraction, but we can not make a final conclusion of the effectiveness of Chinese herb for AMI base on this meta analysis.2. Retrospective cohort study on the effect of Chinese herb on long-term prognosis of AMIMethod:... |
PDF Full Text Request