摘要
目的基于疾病负担循证遴选我国示范乡镇卫生院治疗腰椎间盘突出症的基本药物。方法应用本系列研究之二制定的循证评价与遴选标准、方法和流程,循证评价并推荐乡镇卫生院治疗腰椎间盘突出症的基本药物。结果①共纳入6个临床指南,含5个循证指南。②各国指南共涉及腰椎间盘突出症治疗药物4类35种。③对乙酰氨基酚和布洛芬均被WHO EML(2011)、NEML(2009)、CNF(2010)推荐,指南证据相对较多,质量较高;阿司匹林、吲哚美辛和地西泮均被3个目录推荐,证据数量相对较少,质量相对较低。④5个推荐药物国内均有相应剂型和规格上市,药物价格可负担(每日费用0.31～3.38元)。⑤国内低质量研究表明,布洛芬和阿司匹林对症治疗腰椎间盘突出有效(有效率63%～84.5%),但效果均低于各试验药物(有效率88.60%～95.2%)。未检索到其他药物疗效和经济学评价的中文研究证据。结论①腰椎间盘突出症药物以对症治疗为主。②药物推荐:强推荐对乙酰氨基酚和布洛芬,弱推荐阿司匹林、吲哚美辛和地西泮。③国内腰椎间盘突出药物治疗相关研究证据较少,缺高质量指南。④建议循证制定我国腰椎间盘突出症的临床指南,指导临床治疗;基于当前国内外证据基础,在实践中证实药物疗效。
Objective To evaluate and select essential medicine for herniated lumbar disc based on the burden of disease for township health centers located in eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager （RevMan） 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results （1） Six clinical guidelines on herniated lumbar disc were included, five of which were evidence-based. （2） In total, there were 35 medicines （of four classes） listed in the guidelines. （3） We offer a strong recommendation for paracetamol and ibuprofen as essential medicine and a weak recommendation for aspirin, indometacin and diazepam according to WHOEML （2011）, NEML （2009）, CNF （2010）, clinical guidelines and the quantity and quality of evidence. （4） Five recommended medicines have been marketed in China with the dosage forms and specifications corresponding to guidelines and their prices were affordable （0.31 to 3.38 yuan daily）. （5） Results of domestic low-quality studies indicated that ibuprofen and aspirin were effective with efficiencies of 63% to 84.5%; however, both of which were less effective than other trial medicines （efficiencies： 88.60% to 95.2%）. We didn＇t find any efficacy or pharmacoeconomic evidence of other medicines in Chinese literature databases. Conclu- sion （1） Pharmacotherapy should focus on symptomatic treatment of herniated lumbar disc. （2） We offer a strong rec- ommendation for paracetamol and ibuprofen used in the treatment of herniated lumbar disc and a weak recommendation for aspirin, indometacin and diazepam. （3） There is lack of evidence and high-quality guidelines on pharmacot
出处
《中国循证医学杂志》
CSCD
2012年第8期1011-1016,共6页
Chinese Journal of Evidence-based Medicine
基金
"十一五"国家科技支撑计划重点项目"乡镇卫生院药物配置与物流关键技术研究与产品开发"(编号:2008BAI65B22)
关键词
乡镇卫生院
基本药物
循证评价与遴选
腰椎间盘突出症
Township health center
Essential medicine
Evidence-based evaluation and selection
Herniated lumbar disc
