半夏白术天麻汤治疗后循环缺血性眩晕的系统评价

目的 系统评价半夏白术天麻汤治疗后循环缺血性眩晕的有效性、安全性。方法 计算机检索中国学术期刊全文数据库（CNKI）、万方数据知识服务平台（Wanfang Data）、维普中文期刊全文数据库（VIP）、中国生物医学文献数据库（CBM）、Cochrane Library、PubMed、Embase、Web of Science等数据库，筛选出半夏白术天麻汤治疗后循环缺血性眩晕的随机对照试验（RCT），检索时限从建库至2023年6月30日。应用Cochrane Handbook 5.1评价文献质量，RevMan 5.3评价软件进行Meta分析。结果 共纳入22项RCTs，包括患者1 763例患者，试验组（半夏白术天麻汤联合化学药治疗或常规治疗） 887例、对照组（单用化学药或常规治疗） 876例。Meta分析结果显示：在提高总有效率方面［OR＝4.10，95% CI（2.95，5.70），P＜0.000 01］，在改善全血高切黏度方面［SMD＝-0.88，95% CI（-1.30，-0.46），P＜0.000 1］、改善全血低切黏度方面［SMD＝-1.55，95% CI（-1.84，-1.25），P＜0.000 01］，在增加基底动脉平均血流流速方面［SMD＝1.32，95% CI （0.85，1.78），P＜0.000 01］，在增加左/右椎动脉平均血流流速方面［SMD＝2.08，95% CI （1.15，3.00），P＜0.000 1］/［SMD＝2.04，95% CI （1.10，2.98），P＜0.000 1］；在改善恶心呕吐症状评分方面［SMD＝ - 4.18，95% CI（-6.14，-2.21），P＜0.000 1］、头晕目眩症状评分方面［SMD＝-1.13，95% CI（-1.87，-0.40），P＝0.002］，试验组均优于对照组。研究中明确为不良反应者10例，症状为皮疹或胃肠道不适。结论 半夏白术天麻汤联合化学药治疗或常规治疗，可以明显提高后循环缺血性眩晕的总有效率、改善血流指标、改善恶心呕吐及头晕目眩症状评分，并且不良反应少且轻微，具有安全性及有效性。但由于此次纳入的文献中样本量偏小，需采用更多大样本、设计严谨的临床试验方案提高证据质量级别。

Systematic review of Banxia Baizhu Tianma Decoction for treatment of vertigo caused by posterior circulation ischemia

Objective To systematically evaluate the efficacy and safety of Banxia Baizhu Tianma Decoction for posterior circulation ischemic vertigo. Methods Databases such as CNKI, Wanfang Data, VIP, CBM, Cochrane Library, PubMed, Embase, Web of Science were searched by computer from foundation to June 30, 2023, for the randomized controlled trial (RCT) of Banxia Baizhu Tianma Decoction in the treatment of posterior circulation ischemic vertigo. The Cochrane Handbook 5.1 evaluation of literature quality and RevMan 5.3 evaluation software were used to conduct Meta-analysis. Results A total of 22 RCTs were included in the Meta-analysis, with a total sample size of 1 763 cases, 887 cases in the treatment group (Banxia Baizhu Tianma Decoction combined with western medicine/conventional treatment) and 876 cases in the control group (western medicine/ conventional treatment alone). Meta-analysis results showed: in terms of improving the total efficacy rate OR = 4.10, 95%CI (2.95, 5.70), P < 0.000 01]; improving whole blood high shear viscosity SMD = -0.88, 95%CI (-1.30,-0.46), P < 0.000 1], and whole blood low shear viscosity SMD=-1.55, 95%CI (-1.84, -1.25), P < 0.000 01]; increasing the mean blood flow velocity of basilar artery SMD = 1.32, 95%CI (0.85, 1.78), P < 0.000 01]; increasing the mean blood flow velocity of left vertebral arteries SMD = 2.08, 95%CI (1.15, 3.00), P < 0.000 1] and mean blood flow velocity of right vertebral arteries SMD = 2.04, 95%CI (1.10, 2.98), P < 0.000 1]; improving nausea and vomiting and vertigo symptom score SMD = - 4.18, 95%CI (- 6.14, - 2.21), P < 0.000 1], dizziness and vertigo symptom score SMD = -1.13, 95%CI (-1.87, -0.40), P = 0.002], treatment group was better than control group. There were 10 cases reported as adverse reactions in the study, with symptoms such as rash or gastrointestinal discomfort. Conclusion The results showed that Banxia Baizhu Tianma Decoction combined with western medicine/conventional treatment could significantly improve the total efficacy rate of posterior circulation ischemic vertigo, improve blood flow indicators, improve nausea and vomiting and dizziness and vertigo symptom score, and had few and mild adverse reactions, with safety and efficacy. However, due to the small sample size, more large-sample, rigorous design, protocols are needed to improve the quality level of evidence.