| Objective:A net-work meta-analysis was used to evaluate the effectiveness and quality of life of saline nasal rinses of different concentrations and volumes combined with multiple drugs in the treatment of allergic rhinitis.Methods:The databases of Pub Med,EMbase,The Cochrane Library,CNKI,Wan Fang Data,VIP and CBM were searched by computer to collect randomized controlled trials of nasal irrigation with different concentrations and volumes of saline alone or in combination with medication for the treatment of allergic rhiniti,and each database was searched from the time of build to April 2021 April.Import the retrieved documents into the literature management software Endnote X9.After removing duplicates,two researchers read the abstracts to exclude irrelevant literature according to the established inclusion and exclusion criteria,perused the full text to determine the final included RCTs;second,the study-related content was extracted from the literature according to the data extraction form;third,risk of bias assessment of included studies using the RCT Risk of Bias Assessment Tool in the Cochrane Systematic Assessor’s Handbook version 5.1.0,followed by a net-work Meta-analysis with Stata 15.0.Results:A total of 36 RCTs including 3209 patients with allergic rhinitis involving 16 interventions were included.In terms of improving nasal symptom scores in patients with AR,21 publications including 13 interventions were finally included in the adult group,totaling 1867 individuals,and the results from the two-by-two comparison showed that isotonic small volume saline + INS,hypertonic large volume saline + INS,isotonic large volume + INS,hypertonic very large volume + INS,and isotonic very large volume +INS were superior to the blank control,hypertonic small volume,isotonic small volume,and isotonic small volume,isotonic small volume,hypertonic very large volume,and isotonic very large volume saline rinse(P<0.05);INS and isotonic large volume saline alone were all better than hypertonic small volume,isotonic small volume,hypertonic very large volume,and isotonic very large volume saline rinse(P<0.05);isotonic small volume + INS and isotonic very large volume + INS were better than INS alone(P<0.05)(P<0.05);hypertonic large volume and isotonic large volume saline flushing was better than isotonic small volume saline flushing(P<0.05);isotonic large volume flushing was better than hypertonic very large volume saline flushing(P<0.05);SUCRA value ranking results: hypertonic very large volume saline +INS> isotonic small volume saline +INS>isotonic very large volume saline +INS> hypertonic large volume saline +INS> isotonic large volume saline> isotonic large volume saline +INS> INS alone> hypertonic large volume saline> hypertonic small volume saline> isotonic small volume saline> J hypertonic very large volume saline> isotonic very large volume saline> blank control.In terms of improving nasal symptom scores in patients with AR,the pediatric group ultimately included 11 publications including 13 interventions in a total of 922 individuals.From a two-by-two comparison,INS alone,isotonic small volume saline +AHs,isotonic very large volume saline + AHs,hypertonic small volume saline,hypertonic large volume saline,isotonic large volume saline,isotonic very large volume saline,hypertonic large volume saline + INS,and isotonic very large volume saline +INS were superior to the blank control(P<0.05);isotonic small volume saline + INS,hypertonic large volume isotonic small volume saline + INS,hypertonic large volume saline + INS,and isotonic very large volume saline + INS were all superior to any of AHs,hypertonic small volume saline,isotonic large volume saline,hypertonic very large volume saline,and isotonic very large volume saline alone(P<0.05);isotonic small volume saline + INS was superior to INS alone(P<0.05);hypertonic large volume saline+ INS was more effective than isotonic small volume saline + AHs(P<0.05);and hypertonic large volume saline + INS was more effective than isotonic small volume saline + INS(P<0.05).AHs(P<0.05);hypertonic large volume saline + INS,isotonic very large volume saline + INS were better than isotonic very large volume saline + AHs(P<0.05);INS alone was better than hypertonic small volume saline,isotonic large volume saline,isotonic very large volume saline washout(P<0.05);hypertonic large volume saline washout was better than isotonic large volume saline,hypertonic very large volume saline(P<0.05);hypertonic large volume saline washout was better than isotonic large volume saline,hypertonic very large volume saline(P<0.05).(P<0.05);SUCRA value ranking results: hypertonic large volume saline + INS > isotonic small volume saline + INS > isotonic very large volume saline + INS > hypertonic large volume saline > INS alone > isotonic very large volume saline + AHs > isotonic very large volume saline + AHs > hypertonic very large volume saline > AHs alone > isotonic very large volume saline> hypertonic small volume saline> isotonic large volume saline>blank control.In terms of improving patients’ quality of life,the adult group ended up including 10 publications including 7 interventions for a total of 768 individuals.In a two-by-two comparison,isotonic very high volume saline nasal irrigation + INS medication was superior to INS alone and small volume isotonic saline nasal irrigation(P<0.05);SUCRA values ranked the results: isotonic very high volume saline nasal irrigation + INS medication > isotonic high volume saline + INS medication > isotonic high volume saline > hypertonic very high volume saline > INS medication alone > isotonic isotonic very large volume saline > isotonic small volume saline.Conclusion:Current evidence shows that nasal irrigation with saline is helpful in improving nasal symptoms in adult or pediatric patients,with differences in the degree of improvement in patient symptoms and quality of life with various concentrations or volumes of saline nasal irrigation alone or in combination with different medications.Hypertonic very high-volume saline + intranasal corticosteroids,isotonic very high-volume saline + intranasal corticosteroids are better than others in improving the patient’s nasal symptom score and quality of life;hypertonic high-volume saline +intranasal corticosteroids are better in improving nasal symptoms in children.When saline irrigation alone is used,isotonic high-volume saline is better for adults and hypertonic high-volume saline is better for children. |
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