Systemly Quality Evaluat The Literatures Of Insomnia Treatment Use Chinese Medicine And Western Medicine And Meta Analysis

The BackgroundInsomnia is a common and polidisease in the gynecology.Most of the foreign medical adopt the hypnotics therapeusis,but long-term taking medicine can result to side effect such as dizziness,the headache,to be addicted to rests, absent minded,despondent,disgusting,the vomit,the diarrhea or the constipation,the urination difficult,has a dream,the sexual desire to reduce, the ataxia and so on.In the ancient and modern literature,it has been regarded and reported that the Chinese traditional medicine is sure effect to the climacteric period.So the systematic evaluation of these treatment is very important.Now the clinical investigation does not think highly of the methodology and affects the extence of the investigative conclusion and the admittance of the western medical.The method and result of the Evidence Based Medicine and systermatic analysis has been admitted and thought highly of by the international-medicine and the medical-decision department day by day.To utilize the Evidence-based medicine and the method of systematic analysis.The Meta-analysis of the multipdate of the literature can lead the Chinese Traditional to the world, to the modern.The ObjectiveOrder to obtain an overview of modern Chinese medicine and Western medicine treatment of insomnia in the quality of the clinical literature,and in clinical study,the application of scientific research methods,problems with the quality of research to evaluate the overall level and on this basis,the Chinese medicine and Western medicine treatment of insomnia in clinical make an objective analysis of efficacy for future prospective study of similar design to provide the methodology of scientific research based on the guidance of clinical decision-making,and then found a truly effective treatment in Chinese medicine and western medicine.The MethodsThe matched-control literatures are those published in the civil.To investigate the clinical effect of TCM that it helps insomnia. Literature-retrieved data:CNKI WEB,during the earliest year according to Keyword Spotting literature-2007.On the basis of the screening criteria to enter into the system of quality evaluation of the literature:(1)The corrent of the article hints the report of the clinical investigation of the climacteric period.(2) The grouping of the article appears the word of "random".It has the good balance between groups and comparance.(3)The article should do statistic analysis to some samples.Based on the principle and the method of DME,formulat the Systematic Review Table of the treatment article of the Chinese herbal and western medicine treatment to the climacteric period.It has made statistic analysis from 9 lines.Such as randomization the balance of groups.The inclusion and exclusion criteria,control,sample size,blind-method,statistics method,objects sdandardization,the effect judgement standardization,etc.Calculate the percentage of all kinds of states and evaluate the quality.Then utilize the RevMan to procee Meta analysis of random effect model.I have made sensitivity analysis to different inclusion criteria results and analized publication bias using funnel plots.The Conclusion:1.Traditional Chinese medicine part(1) Systematic ReviewRetrieve literatures about insomnia and "lack of sleep" in the basis of the total are 57 randomized controlled trial literatures meet the inclusion criteria.The whole randomized quality is rather low.There are only 1 pieces are randomization perfectly.The balance between groups which posses comparance are 47 pieces.There are 2 trials adopt the TCM(Traditional Chinese Medicine ) treatment with syndrome differentia and foreign medical diagonosion.The criteria percentage is 3.51%.There are 49 pieces adopt TCM treatment with syndrome differentiation.The criteria percentage is 85.96%.There are 3pieces adopt the foreign diagonosion criteria.The percentage is 5.26%.There are 51 pieces have clear inclusion-creteria.The percentage is 89.47 %.There are 32 pieces have clear exclusion-creteria.It is 56.14%.The sample definition is discompact.There are no artictes explain the analysis of the calculation method of sample size and ITT(Intention treatment analysis). There are 1 pieces have latent allocation and conation therapeusis;The articles that apply blind method are very few,only 4 pieces.(the double blind method is 3,the single blind method is 1).The most articles have statistical test,and mostl statistical method are generally right.There are 0 pieces make any interpretation about statistical method.The 57 articles evaluate from many lines,such as:The TCM therapeusis,the Standardizatiaon of the experimental medicine,the medicine conformation,the medicine type,dose,usage,course,etc. I regard initially that the better standardization are 0 pieces,the good are56 pieces,about 98.25%,the normal are 1 pieces,about 1.75%,48pieces have effect judgement,about 84.21%.There are 9 pieces that regard Chinese TCM to be control,about 15.79%.43 pieces regard western medicine to be control, about75.44%.5 pieces regard the combination of TCM and western medicine to be control,about 8.77%.11 pieces reported adverse reaction,about 19.30%. 8 pieces have flow-up,about 14.04%.(2) Meta analysisTakes the same curative effect determination standard in 57 traditional Chinese medicine literature "Chinese medicine to treat an illness the card diagnosis curative effect standard","the traditional Chinese medicine new medicine treatment losing sleep clinical research guiding principle",and has the same control group "estazolam or diazepam" and the indication has the commeasurability,in order to carries on the meta analysis under the same condition and make the literature merge,finally obtains 2 numbers of classes according.①5 uses "Chinese medicine to treat an illness the card diagnosis curative effect standard" the curative effect determination standard research curative effect analysis:OR=3.46,95%CI[1.84,6.48]。Z=3.87, P=0.0001②3 uses "traditional Chinese medicine new medicine treatment losing sleep clinical research guiding principle"curative effect determination standard research curative effect analysis:0R=2.71,95%CI[1.60,4.61]。Z=3.69,P=0.0002The above two groups P<0.05 have statistics significance,indicated that treatment group's treatment effectiveness obvious good in control group,namely demonstration traditional Chinese medicine treatment insomnia has the very good curative effect.2.Western medicine part(1) Systematic ReviewRetrieve literatures about insomnia in the basis of the total are 35 randomized controlled trial literatures meet the inclusion criteria.The whole randomized quality is rather high.There are 8 pieces are randomization perfectly.The balance between groups which posses comparance are 33 pieces. There are There are 34 pieces adopt the foreign diagonosion criteria.The percentage is 97.14%.There are 1 pieces has not stated treatment with syndrome differentiation.The criteria percentage is 2.86%.There are 35 pieces have clear inclusion-creteria.The percentage is100 %.There are 32 pieces have clear exclusion-creteria.It is 100%.The sample definition is discompact.There are no artictes explain the analysis of the calculation method of sample size.There are 5 pieces have ITT(Intention treatment analysis),5 pieces have latent allocation and conation therapeusis; The articles that apply blind method are many,22 pieces.(the double blind method is22,the single blind method is 0).The most articles have statistical test,and mostl statistical method are generally right.There are 35 pieces make any interpretation about statistical method.The 35 articles evaluate from many lines,such as:The western medicine therapeusis,the Standardizatiaon of the experimental medicine,the medicine conformation,the medicine type,dose, usage,course,etc.I regard initially that the better standardization are 0 pieces,the good are35 pieces,about 100%.35pieces have effect judgement, about 100%.There are 35 pieces regard western medicine to be control,about 100%.34 pieces reported adverse reaction,about 97.14%.16 pieces have flow-up, about 45.71%.(2) Meta analysis Takes the same curative effect determination standard in 35 western medicine literature "SDRS",and has the same control group "zopiclone", "zolpidem" and the indication has the commeasurability,in order to carries on the meta analysis under the same condition and make the literature merge,finally obtains 2 numbers of classes according.①14 uses "zopiclone" for control group's literature curative effect analysis:OR=0.88(The rate of effect between experiment and control), 95%CI[0.71,1.08],Z=1.23,P=0.22②3 uses "zolpidem" for control group's literature curative effect analysis:OR=1.28,95%CI[0.85,1.93],Z=1.16,P=0.25The above two groups P>0.05 do not have statistics significance, indicated that treatment group's treatment effectiveness equates in the control group,namely the demonstration western medicinetreatment group and the control group curative effect are equally good,have the good curative effect.DiscussionBecause of the spreadout of DME among China and the West clinical and scientific research personel has gain well result.The western medicine clinical scientific research quality is relatively good.The TCM clinical scientific research has also gain much amelioration.There are many problems in practicing scientific research personnel has gain Well result.The TCM clinical scientific research has also gain much amelioration.There are many problems in practicing scientific research with RCT which need the most demonstration intensity.Such as:allocation method,sample size etc.So,we should procee strict,multicentric randomized double blind control trail,to provide more reasonable proof.Morever included the choice of effect judgement marker,the observation of omitted and observed reaction,the normalization of the clinical trial report etc.need to pay attention.The quantity of inclusion is low,and the quality is not high.So the demonstration intensity is weak.We need much more high quality trail to add the demonstration intensity. However western medicine when carries on the clinical scientific research the question are few,but still had the progress space in high grade research's quantity.Conclusion 1.It shows that documents study the analysis results of quality,Chinese medicine cure Insomnia of treating contrast in the research document report at present,there are a lot of questions.Display the application studying about the epidemiology method to pay littleattention to mainly,clinical testing is regulatory and relatively bad,it is difficult for the conclusion of clinical research to be generally acknowledged.Western medicine cure Insomnia of treating contrast in the research document report at present is fewer questions,clinical testing is regulatory and relatively good.2.Incorporated into the article on the Meta-analysis showed that traditional Chinese medicine treatment insomnia the curative effect part,the traditional Chinese medicine treatment group is more effective than the western medicine control group;The western medicine treatment insomnia curative effect part, the western medicine treatment group and the western medicine control group is similarly effective.The traditional Chinese medicine or western medicine treatment losing sleep all has certain curative effect,has the very good research prospect.Anyway if there were more high quality article about the Chinese herbal and western medicine treating insomnia,the causality of future research will be more intense,anticipated that has the high grade completely stochastic comparison clinical literature quantity to come to the research result to be able a progress confirmation,thus does for the clinical decision-making serves well.