| Objective1.This study was to explore the clinical efficacy and safety of Kuanxiong aerosol(KXA)on patients with chest pain and distress pre hospital,and analyze the difference of clinical efficacy of chest pain and distress caused by different types of diseases.2.To investigate the influence of health education pre hospitalization on the way of seeking medical treatment and the time of first medical contact for patients with chest pain.Methods1.4 English database(Pubmed,Web of Science,Embase,COCHRANE LIBRARY)and 4 Chinese database(Wanfang Data,China Zhiwang(CNKI),VIP(VIP),and China Biomedical Literature Service System(Sinomed))were searched for random control trials related to the treatment of angina pectoris with KXA from established time to 1st August 2022.The primary outcomes included chest pain relief rate,electrocardiogram relief rate,and incidence of adverse reactions.The REVMAN5.3 software was used for risk of bias evaluation,META analysis,and published bias analysis,the GRADE(Grades of Recommendation,Assessment,Development,and Evaluation)system was used to evaluate the quality of evidence.2.This study was approved by the Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine(N0.BF2020-224-01).200 patients were recruited in Guangdong provincial hospital of Chinese medicine from January 2021 to November 2021,they were randomly divided into KXA group and Nitroglycerin Aerosol(NA)group according to 1:1 through SAS 9.2 software.① Experiment group:Kuanxiong Aerosol group,patients received KXA by sublingual spray for 3 puffs,if symptoms were not relieved,KXA was given again after 5 min.② Control group:Nitroglycerin Aerosol group,patients received NA by sublingual spray for 1 puff(1 puff=5mg NA).All the intervention duration last for 12 weeks and received health education pre hospitalization.The alleviation rate and time of chest pain,the degree of chest pain,history of chest pain,health education experience,medical treatment methods,time from chest pain to first medical contact,and Seattle Angina Scale score were recorded.The number of chest distress and pain times,the number of aerosol use,the number of calling 120 times and adverse reactions after 12 weeks’ treatment were also recorded for analysis.Results1.Systematic review results:A total of 19 studies were included with a total of 2,487 patients.All the 19 studies mentioned random distribution,1 study adopted random number method,8 studies used digital random tables,and 1 study used random sampling method groups.But only two studies mentioned the blind method,which were both single-blind methods.The results of META analysis showed that the chest pain relief rate of KXA was higher than that of the NA group[RR=1.15,95%CI(1.06,1.25),P<0.05].The electroelectrocardiogram improvement rate of KXA group was similar to the control group[RR=1.04,95%CI=(0.99,1.10),P= 0.14].While the incidence of adverse reactions in KXA was significantly lower than NA group[RR=0.41,95%CI=(0.33,0.52),P<0.00001].2.The results of clinical trial:(1)After the first treatment,compared with the NA group,the immediate effect(the immediate relief rate of chest distress and pain)was better than nitroglycerin aerosol(P=0.005),KXA group could effectively alleviate the degree of chest tightness and pain in patients and reduce chest tight pain NRS scores(P<0.05),the amplitude of the NRS score reduction was higher than the NA group(P<0.05).There was no significant difference between the two groups in the effective rate of relieving chest distress and pain at 5 minutes,10 minutes and 30 minutes(P>0.05),but the total remission rate of KXA at 10 minutes and 30 minutes after treatment was 34.0%and 72.2%,respectively,which was significantly higher than that in the nitroglycerin aerosol group(20.8%and 59.4%).(2)After 12 weeks of treatment,attack times of chest tightness and pain,times of aerosol use,degree of chest tightness and pain,and Seattle Anginary scale score between the two groups had no statistical differences(P>0.05).The symptoms of chest tightness and pain in the KXA group were all reduced to mild,but NA group still had 2 cases(2.1%)of moderate pain.(3)The effect of KXA and NA had no statistical differences in chest pain caused by different types of diseases(P>0.05),but the Seattle score of patients with non-cardiogenic chest pain in the KXA group was higher than that in the NA group(P=0.041).(4)The first medical contact time is negatively related to the NRS score after the first medication(R=-0.201,P=0.005).(5)There were 3 patients with adverse reactions(3.1%)in the KXA group,and 8(8.2%)in NA group,but it had no statistically difference between the two groups(P=0.213)3.After 12 weeks of health education,there was no significant difference between the two groups in the improvement of the Seattle Angina Scale score(P>0.05),but it was difference before and after health education.4.Patients with health education experience paid more attention to chest pain and tended to call 120 early.There was a statistical difference between the two groups in the time of first medical contact(P<0.05)Conclusion1.The clinical efficacy of KXA in patients with prehospital chest tightness and pain was comparable to that of nitroglycerin aerosol,but KXA had fewer adverse reactions,and had similar efficacy on cardiogenic and non-cardiogenic chest tightness.Therefore,when the diagnosis of chest tightness and pain before hospital was not clear,it was safer to use KXA therapy.2.The immediate treatment effect of KXA in patients with prehospital chest and tightness was significantly better than that of NA,the immediate relief rate of chest pain after the first administration,the relief rate within 30 minutes,and the total relief rate after 12 weeks of KXA were all higher than that of NA,especially the immediate effect after the first administration,KXA had more advantages in relieving chest tightness and pain.3.The time of first medical contact was negatively correlated with the efficacy of the first drug treatment.The results showed that the shorter the time of first medical contact,the lower NRS and the better relief of chest tightness and pain.It was recommended to use drug therapy as soon as possible,and the sooner,the better.4.Patients with health science education experience were more inclined to call 120 for medical treatment when chest tightness and pain occurred,which can significantly shorten the FMC time.After immediate treatment,the chest tightness and pain relief were more obvious,and the chest tightness and pain relief rate was higher,indicating that the health science education group could improve patients’ awareness and attention to chest pain,especially for patients without health science experience,which could effectively improve the quality of life of patients. |
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