心肌梗死中醫防治臨床研究證據圖

張曉雨 鐘長鳴 關曼柯

摘要 目的：應用證據圖方法，系統檢索與梳理心肌梗死中醫防治臨床研究文獻，了解該領域證據分布。方法：檢索中國知網、萬方、維普、PubMed，EMbase，Web of Science數據庫，時限從2000年1月至2018年11月。納入心肌梗死中醫防治臨床研究、系統評價、指南與路徑研究。采用文字描述結合圖表分析證據分布特征。結果：納入文獻1 664篇，分析了臨床研究發表年度趨勢、研究類型、研究規模;證候、體質臨床研究;中醫療法類別及主要方案;中醫防治方案的評價領域、應用調查、作用環節、干預時機、適應人群和病癥;系統評價方法學質量及結論;指南與臨床路徑研究。結論：目前在心肌梗死中醫病因及體質研究、中醫非藥物療法、生命質量及情志心理療效評價、預防作用及超早期干預（包括急救）領域研究證據較少，臨床研究和系統評價質量有待提高。

關鍵詞 中醫;心肌梗死;臨床研究;證據圖;綜述;方法學;系統評價;優先領域

Abstract Objective：To systematically retrieve and summarize clinical study literatures on traditional Chinese medicine（TCM）for myocardial infarction（MI）prevention and treatment by using the method of evidence map，and to understand evidence distribution in this field.Methods：The clinical study，systematic review，guidelines and path study related to TCM for MI prevention and treatment，published between January 2000 and November 2018 were included after searching databases like CNKI，Wanfang，VIP，PubMed，EMbase and Web of Science.The distribution of evidence was analyzed by text description，tables and graphs.Results：A total of 1664 literatures were included.They were analyzed in following aspects：annual trend of publication，study type and size of clinical study; clinical study on syndromes and constitutions; classifications of TCM therapeutic methods and main schemes; evaluation areas，application and investigation，link of action，intervention timing，intended population，diseases and symptoms of TCM therapeutic schemes; systematic review on quality and conclusion of methodology; guidelines and clinical path study.Conclusion：At present，there is less evidence related to TCM etiology and constitutions in MI，TCM non-medicine therapy，efficacy evaluation on quality of life and emotional psychology，preventive effects and ultra-early intervention（including first aid）.The quality of clinical study and systematic review needs to be improved.

Key Words Traditional Chinese medicine; Myocardial infarction; Clinical study; Evidence map; Review; Methodology; Systematic review; Priority field

中圖分類號：R242 文獻標識碼：A doi：10.3969/j.issn.1673-7202.2019.10.001

缺血性心臟病是造成2015年全球疾病負擔的主要疾病，其中心肌梗死（MI）是主要死亡原因之一[1]。根據《中國心血管病報告2018》概要公布數據，我國急性心肌梗死（AMI）死亡率總體呈上升態勢[2]。中醫在心肌梗死防治中發揮著重要作用，已有大量研究被發表，但缺乏對該領域臨床研究證據的全面把握。證據圖方法可通過全面檢索所關注問題的相關研究，系統總結各類研究的基本特征及結果，準確展示該領域取得的證據、進展及存在問題，為證據使用者提供該領域研究的全貌，減少研究盲目性[3-4]。……