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目的基于疾病负担,循证评价与遴选我国示范乡镇卫生院治疗急性支气管炎的药物。方法按本系列研究之二制定的方法、标准和流程,参考国内外循证或权威指南的推荐意见,并结合国内相关临床研究证据,循证评价并推荐相关药物。主要用RevMan5.1、GRADEpro 3.6等软件处理数据、评价证据质量。结果①共纳入指南8个(国外7个,国内1个),其中5个为循证制定,3个为结合专家意见制定;②6个RCT(n=816,低质量)结果显示喷托维林止咳有效率为53%～82%,其中3个RCT(n=283)结果显示喷托维林疗效略低于丙卡特罗[RR=0.86,95%CI(0.78,0.94),P=0.001],2个RCT(n=233)表明喷妥维林疗效略低于中药汤剂[RR=0.82,95%CI(0.74,0.91),P<0.001];其不良反应主要为恶心、心悸等,发生率为0～2.4%。每日费用成人约为0.20元,儿童为0.08元,均为口服用药,适用性较好;③6个RCT(n=403,低质量)结果显示右美沙芬缓解咳嗽有效率为47.0%～95.3%,其中1个RCT(n=60,低质量)显示氢溴酸右美沙芬滴鼻剂优于空白组[RR=3.71,95%C(I1.91,7.21)],1个RCT(n=43,低质量)表明口服右美沙芬有效率优于安慰剂[RR 1.74,95%CI(1.13,2.66)],1个RCT(n=300,中等质量)显示右美沙芬有效率优于喷托维林[RR=1.16,95%CI(1.07,1.26)],1个观察性研究(n=121,低质量)显示右美沙芬5天有效率为66.5%;其不良反应主要有口干、头晕、恶心等,发生率为2%～30%。结论①强推荐右美沙芬用于缓解急性支气管炎引起的干咳;②弱推荐喷妥维林对症止咳治疗;③不推荐常规使用抗生素、β2受体支气管激动剂及黏液溶解药物;④建议开展针对急性支气管炎的大规模多中心随机双盲对照临床及经济学研究,以生产高质量本土化证据。
Objective Based on the burden of disease, evidence-based evaluation and selection of our model township hospitals for the treatment of acute bronchitis drugs. Methods According to the methods, standards and procedures developed in this series of studies, refer to the recommendations of evidence-based or authoritative guidelines both at home and abroad, and in combination with evidence from clinical researches in China, evaluate and recommend relevant drugs based on evidence. The main use RevMan5.1, GRADEpro 3.6 and other software to process data, evaluate the quality of evidence. Results ① A total of 8 guidelines (7 in foreign and 1 in domestic) were included in the guidelines, of which 5 were evidence-based and 3 were based on expert opinion. The results of 6 RCTs (n = 816, low quality) The efficacy of cough-relieving cough was 53% -82%. Three RCTs (n = 283) showed that the efficacy of pentoxirin was slightly lower than that of procaterol [RR = 0.86,95% CI 0.78,0.94, P = 0.001] , And two RCTs (n = 233) showed that the efficacy of pentobargin was slightly lower than that of traditional Chinese medicine decoction (RR = 0.82,95% CI 0.74,0.91, P <0.001). The adverse reactions were mainly nausea and palpitations, The incidence was 0 ~ 2.4%. The daily cost was about 0.20 yuan for adults and 0.08 yuan for children, all of which were used orally for better applicability. Results of 6 RCTs (n = 403, low quality) showed that the effective rate of dextromethorphan relieving cough was 47.0% -95.3% (N = 60, low quality) showed that dextromethorphan hydrobromide nasal drops were superior to the blank group [RR = 3.71,95% C (I1.91,7.21)] and one RCT (n = 43, low quality) showed that dextromethorphan was more effective than placebo [RR 1.74, 95% CI (1.13, 2.66)], and one RCT (n = 300, Tovlin [RR = 1.16, 95% CI (1.07, 1.26)], 1 observational study (n = 121, low quality) showed dextromethorphan 5-day effective rate was 66.5%; its adverse reactions were mainly dry mouth , Dizziness, nausea, etc., the incidence rate of 2% to 30%. Conclusions ① Dextromethorphan is strongly recommended to relieve dry cough caused by acute bronchitis; ② Weak recommend pentobarbitol for symptomatic and cough treatment; ③ routine antibiotics, β2-receptor bronchial agonist and mucolytic drugs are not recommended; A large, multicenter, randomized, double-blind, controlled clinical and economic study of acute bronchitis to produce high quality indigenous evidence.