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目的:系统评价中医通腑泻肺法能否改善急性呼吸窘迫综合征（ARDS）患者的预后及呼吸力学。方法:检索美国国立医学图书馆PubMed数据库、科学网Web of Science、荷兰医学文摘Embase数据库、中国知网（CNKI）及万方数据库等2001年1月1日至2019年6月30日发表的通腑泻肺法治疗ARDS的随机对照试验（RCT）。对照组采用ARDS常规治疗措施，包括机械通气、俯卧位通气、抗感染、器官功能维护及营养支持等；试验组在对照组基础上，加用以通腑泻肺法为基础的中医药治疗。主要观察指标为院内病死率；次要观察指标为机械通气时间、重症监护病房（ICU）住院时间及呼吸力学参数。由2名研究者独立检索文献、收集数据及评估偏倚风险；应用RevMan 5.3软件完成纳入文献的风险偏倚评估；应用R语言Meta包进行Meta分析，并评价主要观察指标的潜在发表偏倚。结果:共纳入27项RCT、1 763例患者，其中试验组899例，对照组864例。Meta分析结果显示，与对照组相比，试验组院内病死率明显降低〔相对危险度（n RR）＝0.46，95%可信区间（95%n CI）为0.36～0.59，n P<0.000 1〕，机械通气时间及ICU住院时间明显缩短〔机械通气时间：标准均数差（n SMD）＝-1.92，95%n CI为-2.56～-1.29，n P<0.000 1；ICU住院时间：n SMD＝-1.84，95%n CI为-2.49～-1.18，n P<0.000 1〕，氧合指数明显改善（n SMD＝2.26，95%n CI为1.56～2.96，n P<0.000 1），气道峰压、气道平台压、平均气道压、气道阻力明显降低（气道峰压：n SMD＝-1.26，95%n CI为-2.35～-0.18，n P＝0.021 8；气道平台压：n SMD＝-0.61，95%n CI为-1.08～-0.14，n P＝0.010 7；平均气道压：n SMD＝-1.67，95%n CI为-2.93～-0.42，n P＝0.009 1；气道阻力：n SMD＝-0.88，95%n CI为-1.09～-0.67，n P<0.000 1），肺顺应性增加（n SMD＝1.57，95%n CI为0.78～2.36，n P<0.000 1）。发表偏倚评估结果显示，研究院内病死率的15项RCT呈“倒漏斗”形分布，说明无潜在发表偏倚（n P＝0.499）。n 结论:通腑泻肺法可降低ARDS患者院内病死率，缩短机械通气时间和ICU住院时间，改善呼吸力学参数。“,”Objective:To systematically review the effect of Tongfu Xiefei method on prognosis and respiratory mechanics parameters in patients with acute respiratory distress syndrome (ARDS).Methods:The randomized controlled trials (RCT) of Tongfu Xiefei method for ARDS published on PubMed, Web of Science, Embase, CNKI and Wanfang database from January 1st 2001 to June 30th 2019 were searched. Conventional treatment for ARDS that included mechanical ventilation, prone ventilation, anti-infection, organ function maintenance and nutritional therapy were used in the control group. While the Tongfu Xiefei method was applied in the experimental group based on the conventional treatment. The main outcome was in-hospital mortality, and the secondary outcomes included mechanic ventilation time, length of intensive care unit (ICU) stay and respiratory mechanics parameters. Two researchers independently searched the literature, collected data and assessed the risk of bias. The bias risk assessment was completed by RevMan 5.3 software. The Meta-analysis was completed by R software. The potential publication bias of main outcome was evaluation.Results:A total of 27 RCTs were included. There were 1 763 patients, including 899 in the experimental group and 864 in the control group. Meta-analysis showed that, compared with the control group, the in-hospital mortality of the experimental group significantly decreased [relative risk (n RR) = 0.46, 95% confidence interval (95%n CI) was 0.36 to 0.59, n P < 0.000 1], the mechanic ventilation time and the length of ICU stay were significantly shortened [mechanical ventilation time: standard mean difference ( n SMD) = -1.92, 95%n CI was -2.56 to -1.29, n P < 0.000 1; length of ICU stay: n SMD = -1.84, 95%n CI was -2.49 to -1.18, n P < 0.000 1], oxygenation index was significantly improved ( n SMD = 2.26, 95%n CI was 1.56 to 2.96, n P < 0.000 1), airway peak pressure, airway platform pressure, mean airway pressure and airway resistance significantly decreased (airway peak pressure: n SMD = -1.26, 95%n CI was -2.35 to -0.18, n P = 0.021 8; airway platform pressure: n SMD = -0.61, 95%n CI was -1.08 to -0.14, n P = 0.010 7; mean airway pressure: n SMD = - 1.67, 95%n CI was - 2.93 to -0.42, n P = 0.009 1; airway resistance: n SMD = -0.88, 95%n CI was -1.09 to -0.67, n P < 0.000 1), while lung compliance increased ( n SMD = 1.57, 95%n CI was 0.78 to 2.36, n P < 0.000 1). The results of publication bias assessment showed that there was no potential publication bias ( n P = 0.499).n Conclusion:Tongfu Xiefei method is capable of reducing the in-hospital mortality, shortening the mechanical ventilation time and the length of ICU stay, and improving respiratory mechanics parameters for patients with ARDS.