活血利水中药治疗高血压脑出血术后随机对照试验的Meta分析

Meta-Analysis of Randomized Controlled Trials on the Treatment of Hypertensive Cerebral Hemorrhage Post-Operatively with Blood-Activating and Water-Diuretic Traditional Chinese Medicine

摘要: 目的：系统评价活血利水中药对高血压脑出血术后的有效性和安全性。方法：计算机检索国内外数据库(检索时间为建库到2025年4月)，收集活血利水中药联合常规治疗高血压脑出血术后的高质量随机对照试验相关文献，采用RevMan 5.3软件进行Meta分析。结果：纳入分析文献27篇，共2205例患者，其中治疗组1118例，对照组1087例。Meta分析结果显示：与单纯常规治疗相比，联合运用活血利水中药能提高高血压脑出血术后患者的临床疗效[OR = 2.76, 95% CI (2.08, 3.65), P < 0.00001]、改善NIHSS评分[MD = −3.55, 95% CI (−4.95, −2.15), P < 0.05]、改善神经功能评分[MD = −4.05, 95% CI (−5.09, −3.02), P < 0.05]、改善GCS评分[MD = 1.55, 95% CI (1.22, 1.89), P < 0.00001]、改善脑水肿[MD = −5.77, 95% CI (−8.81, −2.73), P < 0.05]、减少血肿体积[MD = −4.47, 95% CI (−6.30, −2.63), P < 0.0001]。由于安全性数据报告严重不足，无法评估该疗法的安全性。结论：在高血压脑出血术后使用活血利水中药联合常规治疗对高血压脑出血患者改善总有效率与神经功能缺损，减少残余脑血肿量及改善脑水肿情况的作用优于单纯常规治疗。尽管现有研究提示活血利水中药可能有效，但由于纳入研究的整体方法学质量低、偏倚风险高、异质性显著且存在发表偏倚，目前证据的确定性极低，结果需谨慎解读。

Abstract: Objective: To systematically evaluate the efficacy and safety of traditional Chinese medicines with blood-activating and water-promoting effects in patients with hypertensive cerebral hemorrhage after surgery. Methods: Computer retrieval of domestic and international databases (search period from database establishment to April 2025) was conducted to collect high-quality randomized controlled trials on the combination of blood-activating and water-promoting traditional Chinese medicines with conventional treatment for hypertensive cerebral hemorrhage after surgery. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 27 articles involving 2205 patients were included in the analysis, with 1118 patients in the treatment group and 1087 in the control group. Meta-analysis results showed that compared with conventional treatment alone, the combination of blood-activating and water-promoting traditional Chinese medicines improved clinical efficacy in patients with hypertensive cerebral hemorrhage after surgery [OR = 2.76, 95% CI (2.08, 3.65), P < 0.00001], improved NIHSS scores [MD = −3.55, 95% CI (−4.95, −2.15), P < 0.05], improved neurological function scores [MD = −4.05, 95% CI (−5.09, −3.02), P < 0.05], improved GCS scores [MD = 1.55, 95% CI (1.22, 1.89), P < 0.00001], improved cerebral edema [MD = −5.77, 95% CI (−8.81, −2.73), P < 0.05], and reduced hematoma volume [MD = −4.47, 95% CI (−6.30, −2.63), P < 0.0001]. No significant abnormalities were observed in safety indicators or adverse reactions. Conclusion: The combination of blood-activating and water-promoting traditional Chinese medicines with conventional treatment after surgery for hypertensive cerebral hemorrhage is more effective than conventional treatment alone in improving overall efficacy and neurological function deficits, reducing residual intracerebral hematoma volume, and improving cerebral edema in patients with hypertensive cerebral hemorrhage. However, further validation by more high-quality studies is needed.