| Objective: To systematically analyze the efficacy and safety of macrolides in the treatment of the chronic rhinosinusitis.To compare the efficacy and safety of different traditional Chinese medicine oral preparations(TCMOPs)for chronic rhinosinusitis based on network Meta-analysis and evaluate the economics of TCMOPs based on the incremental cost-effectiveness analysis.To verify the role of “pharmaceutical care pathway for chronic rhinosinusitis” in the prognosis of patients with chronic rhinosinusitis.To construct the pharmaceutical care pathway for chronic rhinosinusitis based on the meta-analysis,and verify the role of pharmaceutical care pathway for chronic rhinosinusitis in the prognosis of patients with chronic rhinosinusitis.Methods: 1.Systematic evaluation of macrolides: Randomized controlled trials of related articles from inception to March 25,2018 were searched from Pubmed,Embase,Cochrane Library,CNKI and Wangfang by computer.Meta-analysis were performed using RevMan 5.0 and Stata 12.0 software after data extraction and quality evaluation by Cochrane“risk-bias assessment tool”.Meta-analysis were performed using Stata 14.0software.2.Systematic evaluation of TCMOPs: Randomized controlled trials(RCTs)of related articles from inception to March 28,2019 were searched from Pubmed,Embase,Web of Science,Cochrane Library,CNKI,VIP,Wangfang and CBM database by computer.Meta-analysis were performed using Stata 14.0 software after data extraction and quality evaluation by Cochrane“risk-bias assessment tool”.We compared treatment effectiveness,adverse reactions,and treatment costs in each group and evaluated the differences in pharmacoeconomics of different drug regimens based on incremental cost-effectiveness analysis in pharmaceutical economics.3.Validation of pharmaceutical care pathways for chronic rhinosinusitis: Patients with chronic rhinosinusitis who visited the department of otolaryngology,the first affiliated hospital of China Medical University from January 1,2019 to June 31,2019 were randomly collected by lottery.The selected patients were randomly divided into two groups by the random number table method:path groups and non-path groups.Patients in the path group were provided with pharmaceutical care according to the Pharmaceutical care pathway for chronicrhinosinusitis,while patients in the non-path group were provided with routine pharmaceutical care.Patients were then followed up 6 months later to compare the changes in the effective rate and subjective quality of life scores(VAS scores and SNOT-22 scores)between the two groups.Results: 1.Systematic evaluation of macrolides: 25 RCTs were included,involving 2106 patients.The results of Meta-analysis showed that the effective rate[OR=5.33,95%CI(4.03,7.04),P=0.000],marked effective rate[OR=2.65,95%CI(2.20,3.20),P=0.000] and other indicators were statistically significant between the two groups of patients.There were no significant differences in the Lund-Kennedy score [SMD=-2.18,95%CI(-5.61,1.26),P=0.214] and incidence of adverse reactions [OR=0.81,95%CI(0.40,1.65),P=0.569].2.Systematic evaluation of TCMOPs: A total of 69 RCTs was included,relating to 8 TCMOPs(Xanthium rhinitis capsule,Sinusitis oral liquid,Biyuantongqiao granules,Xiangjupian,Biyuanshu oral liquid)and 10385 patients.The results of network Meta-analysis showed that in terms of improving the total efficiency,Sinusitis oral liquid ranked the highest(MeanRank=1.7).Sinusitis oral liquid was better than Biyuanshu oral liquid in improving the effective rate,and the difference was statistically significant[OR=1.91,95%CI(1.05,3.50)].Compared to basic care,the incremental cost-effect ratio of each group was that Sinusitis oral liquid was 22.87,Xiangjupian was 393.5,Biyuantongqiao granules was 37.66,Xanthium rhinitis capsule was 25.90 and Biyuanshu oral liquid was 27.12.3.Validation of pharmaceutical care pathways for chronic rhinosinusitis: VAS scores and SNOT-22 scores were significantly different between the path group and the non-path group after treatment and before treatment.There was a statistically significant difference in the total score of snot-22 between the two groups after treatment(t=-4.42,P<0.05).There were 9 symptoms among the SNOT-22 scores of symptoms,are statistically significant differences,including “pus snot”(t =-3.02,P<0.05),“pain or pressure in the head or face”(t =-4.34,P<0.05),“difficult to fall asleep”(t =-2.47,P<0.05),“Work efficiency decline”(t=-2.14,P<0.05),“inattention”(t=-2.14,P<0.05),“depression,anxiety,irritability”(t=-2.18,P<0.05),“concern”(t=-4.35,P<0.05)and “feeling uneasy or embarrassed”(t=-2.68,P<0.05),“nasal congestion”(t=-2.41,P<0.05)and there was no statistically significant differenceof other 13 symptoms;There was no significant difference in VAS score and effective rate between the two groups after treatment,but there was a tendency to decrease VAS score and increase effective rate between the path group and the non-path group.Conclusion: 1.Systematic evaluation of macrolides: Macrolides have good efficacy in treating chronic rhinosinusitis,which can significantly improve the quality of life of patients with chronic rhinosinusitis and the function of ciliary clearance,reduce the level of inflammatory cytokines and recurrence,and have good security.2.Systematic evaluation of TCMOPs: On the basis of basic treatment,combined with TCMOPs can significantly reduce the inflammatory indicators of patients,improve the quality of life of patients,and has good security.In terms of improving the effective rate,Sinusitis oral liquid is the best among the 5 kinds of TCMOPs,followed by Xiangjupian,Biyuantongqiao granules,Xanthium rhinitis capsule,Biyuanshu oral liquid.In economics,Sinusitis oral liquid is the best,followed by Xanthium rhinitis capsule,Biyuanshu oral liquid,Biyuantongqiao granules,Xiangjupian.3.Validation of pharmaceutical care pathways for chronic rhinosinusitis: Compared with traditional pharmaceutical care,the application of the “Pharmaceutical care pathway for chronic rhinosinusitis” can improve the prognosis of patients with chronic rhinosinusitis,and its effect is mainly reflected in improving the symptoms caused by subjective mental and psychological factors. |
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