我國示范鄉鎮衛生院基本藥物循證評價與遴選之三：普通感冒_《中國循證醫學雜志》

作者：

李鴻浩 ¹ ,  李幼平 ¹ , 王應強 ¹ , 汪俊翔 ² , 侯超 ² , 林逸驍 ² , 王莉 ¹ , 楊曉妍 ¹

1. 四川大學華西醫院中國循證醫學中心（成都 610041）；2. 四川大學華西臨床醫學院（成都 610041）;

關鍵詞：

鄉鎮衛生院基本藥物循證評價與遴選普通感冒上呼吸道感染

DOI：

10.7507/1672-2531.20120142

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目的　循證評價與遴選我國鄉鎮衛生院治療感冒患兒發熱、成人胃腸型感冒的基本藥物。
方法　針對示范鄉院反映的感冒藥物配備問題，應用本系列研究之二制定的基本藥物循證評價與遴選標準、方法和流程，循證評價并推薦相關藥物。采用RevMan 5.1和GRADEpro等軟件統計分析數據和評價證據質量。
結果　① 共納入12個治療指南，其中11個是循證或結合專家意見制定，推薦藥物包括解熱鎮痛、解充血、抗組胺、止咳、祛痰、治療胃腸道癥狀。② 4個RCT（極低質量證據）表明布洛芬混懸液對感冒患兒的解熱效果與對乙酰氨基酚懸浮液相似，其6小時解熱有效率合并結果為RR=1.48，95%CI（0.66，3.30），P=0.34；不良反應主要是消化道不良反應和出汗較多［RR=1.23，95%CI（0.72，2.11），P=0.45］；藥費1.93元/d；口服且不需督導用藥，適用性好。③ 與布洛芬混懸液相比，3個RCT（低質量證據）表明用藥30分鐘、1小時后，對乙酰氨基酚（撲熱息痛）栓劑降低體溫效果較優［MD=–0.16°C，95%CI（–0.21，–0.11），P lt;0.01）與MD=–0.19°C，95%CI（–0.28，0.10），P lt;0.01］；不良反應主要是肛門刺激不適癥狀、皮疹、出汗較多；藥物不良反應［RR=1.84，95%CI（0.62，5.44），P=0.27］；發熱患兒藥費0.90元/d；經肛門用藥，適用性好。④ 與嗎丁啉相比，5個CCT（低級證據質量）顯示藿香正氣軟膠囊治療胃腸道癥狀效果更好，有效率合并結果為RR=3.09，95%CI（2.01，4.75），P lt;0.05；1個RCT（中級證據質量）表明，該藥治療感冒所致胃腸道癥狀總有效率98.06%；無藥物不良反應事件發生；藥費 0.67 元/d；口服，適用性好。⑤ 治療對乙酰氨基酚中毒，國外1項回顧性研究表明，15例（23%）在8小時內給予乙酰半胱氨酸注射液治療的患者無死亡或進展為肝衰竭、腎衰竭。8小時后接受乙酰半胱氨酸注射液治療的患者住院時間 gt;3天，而8小時內接受該藥治療患者僅1天；15 min組肝毒性發生率為0%～9%（95%CI）；25例60 min組為0%～12%（95%CI）；可導致潮紅、皮疹及瘙癢。注射用藥需專業人員監督、指導使用，適用性差；藥費兒童40元/d，成人160元/d。
結論　① 兒童普通感冒發熱對癥治療疼痛不適強推薦布洛芬混懸液、撲熱息痛栓劑；強推薦藿香正氣軟膠囊治療成人感冒胃腸癥狀。弱推薦乙酰半胱氨酸注射液治療對乙酰氨基酚中毒。② 建議盡量報道大樣本對照研究，完善結局指標，以便生產高質量本土化證據。

引用本文： 李鴻浩,李幼平,王應強,汪俊翔,侯超,林逸驍,王莉,楊曉妍. 我國示范鄉鎮衛生院基本藥物循證評價與遴選之三：普通感冒. 中國循證醫學雜志, 2012, 12(8): 868-877. doi: 10.7507/1672-2531.20120142 復制

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1. Paul L, Nicky C, Anne J, et al. Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary. NICE clinical guideline 69, 2008: 13. http://publications.nice.org.uk/respiratory-tract-infections-antibiotic-prescribing-cg69.
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3. Heikkinen T, Jarvinen A. The common cold. Lancet, 2003, 361(9351): 51-59.
4. Kirkpatrick GL. The common cold. Prim Care, 1996, 23(4): 657-675.
5. 李鴻浩, 王莉, 李幼平, 等. 2008～2010年中國西部地區試點鄉鎮衛生院前15位住院疾病比較研究. 中國循證醫學雜志, 2011, 11(6): 622-630.
6. 李鴻浩, 王應強, 李幼平, 等. 循證評價與遴選中國東中西部鄉院基本藥物系列之一: 我國東、中、西部8家示范鄉院2010年住院疾病構成分析. 中國循證醫學雜志, 2012, 12(3): 260-266.
7. 李鴻浩, 李幼平, 王莉, 等. 循證評價與遴選中國東、中、西部鄉院基本藥物系列之二: 評價標準、方法與流程研究. 中國循證醫學雜志, 2012, 12(3): 347-356.
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22. 姜良鐸. 感冒中醫臨床實踐指南. 見: 中國中醫科學院, 組織編寫. 中醫循證臨床實踐指南-中醫內科分冊. 北京: 中國中醫藥出版社, 2011: 311-328.
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