摘要:
Objective:Applying GRADE system to evidence-based evaluate the rationality of dual calcium channel blockers (CCB) treating hypertension,we try to establish a feasible method of evidence-based evaluation of pharmacotherapeutic schemes,and promote the rational use of medicines.Methods:The two kinds of CCB combined treatment of the clinical problem of hypertension ac-cording to the principle of PICO conversion,retrieval related database,according to the set standards for screening and evidence of qual-ity rating results.Then,the evidence quality of original research was rated and each outcome index was comprehensively evaluated.Fi-nally,the rationality of the medicine treatment scheme was evaluated.Results:Dual CCB,namely dihydropyridine(DHP) and nondihy-dropyridine(NDHP),in the treatment of hypertension was graded as evidence-based medicine,but the evidence quality was relatively low.Compared with DHP,dual CCB reduced both blood pressure and the heart rate.Compared with NDHP,dual CCB reduced blood pressure and increased the heart rate.Dual CCB had lower incidence of adverse drug reaction in comparison with monotherapy.Conclu-sion:The GRADE system is an effective method of evidence-based evaluation of pharmacotherapeutic schemes.This result shows that combination therapy of DHP and NDHP increased the therapeutic effects and decreased the adverse drug reactions.However,since the evidence quality is relatively low,more large-sample,multicenter,and high-quality RCTs are required to further proof the efficiency and safety of this combined therapy.%目的:采用GRADE系统评价方法评估临床实践中两种钙通道阻滞剂(calcium channel blocker,CCB)联合治疗高血压的循证证据,以期建立一种可行的寻找药物治疗方案循证证据的工作方法,促进临床合理用药.方法:将两种CCB联合治疗高血压这一临床问题根据PICO原则转换后,检索相关数据库,按设定标准对结果进行筛选和证据质量评级,再对每一个结局指标做综合性评价,最终判断药物治疗方案的合理性.结果:两种CCB联合治疗高血压有循证证据,但证据质量低.具体联合方案为二氢吡啶类(dihydropyridine,DHP)联合非二氢吡啶类(nondihydropyridine,NDHP).与单用DHP相比,DHP与NDHP联合治疗可使血压下降、心率减慢;与单用NDHP相比,联合治疗可使血压下降、心率加快;与单用DHP或NDHP相比,联合治疗不良反应发生率降低.结论:GRADE是一种可行的评估药物治疗方案循证证据的有效方法,结果表明,DHP与NDHP联合治疗高血压疗效增加,不良反应发生率降低,但证据质量低,需开展大样本、多中心的高质量RCT进一步验证联合用药方案的有效性及安全性.