Table2_Effect Western Medicines Combined With Nao-Xue-Shu in Patients With Hypertensive Intracerebral Hemorrhage: A Network Meta-Analysis.DOCX

Purpose: To explore the efficacy of nimodipine, nifedipine, and edaravone (EDA) combined with Nao-Xue-Shu in patients with hypertensive intracerebral hemorrhage (HICH) and to determine the best western medicine combined with Nao-Xue-Shu for treating HICH patients using a ranking method.
Methods: After a comprehensive search of the China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP information database, Chinese Biomedical Database (CBM), PubMed, Embase, and Cochrane Library database from the database establishment 31 December 2021, data extraction and quality assessment were conducted for the included articles. The primary outcome measure was the effectiveness after treatment. Secondary outcome measures were after-treatment the National Institutes of Health Stroke Scale (NIHSS) scores, hematoma volume, perihematoma edema volume, and inflammatory factor expression levels. Statistical analyses were performed using Stata 16.0 and RevMan 5.3.0 software.
Results: We included 19 randomized controlled trials (RCTs) and six non-RCTs. The effective rate after treatment was ranked from the best to the worst as follows: routine cure measure (RCM) + nifedipine + Nao-Xue-Shu, RCM + EDA + Nao-Xue-Shu, RCM + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + EDA, and RCM. The post-treatment NHISS scores from lowest to highest were as follows: RCM + EDA + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + EDA, RCM + nimodipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, RCM + Nao-Xue-Kang, and RCM. The post-treatment hematoma volume from minimum to maximum was as follows: RCM + EDA + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, RCM + Nao-Xue-Kang, and RCM. The post-treatment perihematoma edema volume from minimum to maximum was as follows: RCM + EDA + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, and RCM. For inflammatory factor expression levels after treatment, IL-6 concentration levels after treatment from lowest to highest wasas follows: RCM + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + nimodipine + Nao-Xue-Shu, RCM + EDA + Nao-Xue-Shu, and RCM. TNF-α concentration levels after treatment from lowest to highest was as follow: RCM + nimodipine + Nao-Xue-Shu, RCM + nifedipine + Nao-Xue-Shu, RCM + Nao-Xue-Shu, and RCM.
Conclusion: Nao-Xue-Shu combined with nifedipine showed better effectiveness after treatment in HICH patients compared with the other combinations. Nao-Xue-Shu combined with EDA was more effective for improving neurological function and reducing both hematoma and edema volumes around the hematoma compared with the other combinations. However, Nao-Xue-Shu alone or Nao-Xue-Shu combined with nimodipine may be more effective for reducing proinflammatory factor expression.

研究目的：探讨尼莫地平、硝苯地平、依达拉奉（EDA）联合脑血疏治疗高血压性脑出血（HICH）患者的临床疗效，并通过排序法明确最优的西药联合脑血疏治疗方案，为高血压性脑出血患者的临床治疗提供参考。
研究方法：本研究系统检索自建库至2021年12月31日的中国知网（CNKI）、万方数据库、维普资讯数据库、中国生物医学文献数据库（CBM）、PubMed、Embase及Cochrane图书馆数据库，对纳入的文献进行数据提取与质量评价。本研究的主要结局指标为治疗后临床有效率；次要结局指标包括治疗后美国国立卫生研究院卒中量表（NIHSS）评分、血肿体积、血肿周围水肿体积及炎症因子表达水平。采用Stata 16.0及RevMan 5.3.0软件进行统计学分析。
研究结果：本研究共纳入19项随机对照试验（RCT）及6项非随机对照试验。治疗后临床有效率由高至低排序如下：常规治疗方案（routine cure measure, RCM）+硝苯地平+脑血疏、常规治疗方案+依达拉奉+脑血疏、常规治疗方案+脑血疏、常规治疗方案+尼莫地平+脑血疏、常规治疗方案+依达拉奉、常规治疗方案。治疗后美国国立卫生研究院卒中量表（NIHSS）评分由低至高排序如下：常规治疗方案+依达拉奉+脑血疏、常规治疗方案+尼莫地平+脑血疏、常规治疗方案+依达拉奉、常规治疗方案+硝苯地平+脑血疏、常规治疗方案+脑血疏、常规治疗方案+脑血康、常规治疗方案。治疗后血肿体积由小至大排序如下：常规治疗方案+依达拉奉+脑血疏、常规治疗方案+尼莫地平+脑血疏、常规治疗方案+硝苯地平+脑血疏、常规治疗方案+脑血疏、常规治疗方案+脑血康、常规治疗方案。治疗后血肿周围水肿体积由小至大排序如下：常规治疗方案+依达拉奉+脑血疏、常规治疗方案+尼莫地平+脑血疏、常规治疗方案+硝苯地平+脑血疏、常规治疗方案+脑血疏、常规治疗方案。针对治疗后炎症因子表达水平，治疗后白细胞介素-6（IL-6）浓度由低至高排序如下：常规治疗方案+脑血疏、常规治疗方案+硝苯地平+脑血疏、常规治疗方案+尼莫地平+脑血疏、常规治疗方案+依达拉奉+脑血疏、常规治疗方案。肿瘤坏死因子-α（TNF-α）浓度由低至高排序如下：常规治疗方案+尼莫地平+脑血疏、常规治疗方案+硝苯地平+脑血疏、常规治疗方案+脑血疏、常规治疗方案。
研究结论：相较于其他联合治疗方案，脑血疏联合硝苯地平治疗高血压性脑出血患者的临床疗效更显著。相较于其他联合方案，脑血疏联合依达拉奉在改善神经功能、缩小血肿体积及减轻血肿周围水肿方面效果更优。然而，单纯应用脑血疏或脑血疏联合尼莫地平在降低促炎因子表达层面效果更佳。