2020 年第 1 期 第 15 卷

妊娠期高血压疾病药物干预循证指南的质量评价

Guidelines concerning pharmacological intervention in pregnancy-induced hypertension: a systematic review

作者：刘宇凡闵慧薛小荣胡斌李琼阁

英文作者：

单位：西安市第四医院药剂科710004

英文单位：

关键词：妊娠期高血压；药物干预；循证指南；系统评价

英文关键词：

• 摘要：

• 【摘要】目的    循证评价妊娠期高血压疾病的药物干预指南，分析不同质量指南中药物推荐频次的差异，探讨药物推荐的证据强弱，为妊娠期高血压疾病的治疗提供依据。方法    计算机检索PubMed、Embase、NICE、NGC、GIN、中国知网、万方数据库、维普数据库、医脉通数据库，纳入妊娠期高血压疾病药物干预的循证指南，采用临床指南研究与评估系统（AGREE）Ⅱ评价指南的方法学质量，分析比较各指南推荐用药的异同。结果    共纳入15篇指南，对各领域进行评分，得分最高的领域为“表达的清晰性”［（97±6）%］，其次为“范围与目的”［（95±11）%］。6篇指南推荐妊娠期抗高血压药物主要为拉贝洛尔和硝苯地平，5篇推荐为甲基多巴。13篇指南中推荐先兆子痫的预防用阿司匹林［92.3%（12/13）］和钙剂［38.5%(5/13)］。7篇指南推荐子痫的治疗首选硫酸镁。结论    纳入的15篇循证指南总体评分较高。但各指南对证据级别和推荐强度采用标准存在一定的差异，有待进一步统一完善。

• 【Abstract】Objective    To review the evidence-based guidelines on pharmacotherapy for pregnancy-induced hypertension, to analyse the differences of drug recommendation among different guidelines, and to evaluate the evidence of recommendation, so as to provide rational reference for clinical drug use. Methods    Evidence-based guidelines on pharmacotherapy for pregnancy-induced hypertension were identified using PubMed, Embase, NICE, NGC, GIN, China National Knowledge Infrastructure(CNKI), Wanfang data, VIP and Medlive databases. The methodological quality of guidelines was evaluated according to Appraisal of Guidelines for Research and Evaluation(AFREE)Ⅱ. The differences in recommended drugs were analyzed among guidelines with different quality. Results    Fifteen guidelines were identified and rated. The highest scoring item was "clarity of presentation"［（97±6）%］ and the second was "scope and purpose"［（95±11）%］. Six guidelines recommended labetalol and nifedipine and 5 guidelines recommended methyldopa as the main anti-hypertension drugs. Aspirin［92.3%（12/13）］ and calcium［38.5%(5/13)］ were recommended for the prevention of preeclampsia. Magnesium sulfate was the first choice for eclampsia as mentioned in 7 guidelines. Conclusions    The methodological quality scores of the 15 evidence-based guidelines for pregnancy-induced hypertension are generally high. But there are differences in the evidence quality and recommended strength among them. Standard and consolidated guidelines are still awaited.