Posterior circulation ischemic vertigo (PCIV) can often be used as a precursor symptom of cerebral infarction. It has the characteristics of recurrent attacks, lingering and non healing, which seriously affects the quality of life of patients. However, the clinical efficacy of conventional western medicine treatment is limited. At present, traditional Chinese patent medicines and simple preparations injection has significant efficacy in controlling and alleviating the onset of vertigo. However, in view of the wide variety of traditional Chinese patent medicines and simple preparations preparations, there is a lack of relevant evidence-based medical evidence to evaluate the advantages and disadvantages of various traditional Chinese patent medicines and simple preparations injections.

To evaluate the efficacy and safety of different Chinese herbal injections combined with conventional western drugs in the treatment of PCIV using reticulated Meta-analysis.

A comprehensive search was conducted on CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library up to May 7, 2024, for randomized controlled trials involving TCM injections for the treatment of PCIV. Randomized controlled trial (RCT) on the treatment of post-circulatory ischemic dizziness with herbal injections. The Cochrane risk of bias tool was used to evaluate the quality of the included literature, and RevMan 5.4 and Stata 17 software were used for data analysis.

Forty-nine RCT with 4 556 patients were finally included, involving 13 types of traditional Chinese medicine injections, including Danshen Chuanxiongqin injection, Danhong injection, Shenxiong Putaotang injection, Shenmai injection, Tianmasu injection, Dengzhanhuasu injection, Shuxuetong injection, Honghuahuangsesu injection, Shuxuening injection, Kudiezi injection, Gegensu injection, Xingnaojing injection, Yinxingdamo injection. Net Meta-analysis showed that in terms of vertigo symptom improvement[i.e. Dizziness Disorder Inventory (DHI) score]: the top 3 SUCRA-ranked interventions were Xingnaojing injection (87.2%) , Shenmai injection (73.5%) , and Shuxuening injection (59.6%) in combination with conventional western medicine, respectively; In terms of total clinical effectiveness: the top 3 SUCRA-ranked interventions were Yinxingdamo injection (88.3%) , Tianmasu injection (63.3%) , and Gegensu injection (57.6%) in combination with conventional western medicines, respectively; In terms of improvement of blood flow velocity in left and right vertebral arteries: the top three interventions were Xingnaojing injection (96.2%, 99.2%) , Dengzhanhuasu injection (90.2%, 85.6%) , and Honghuahuangsesu injection (69.3%, 79.4%) in combination with conventional western medicines; In terms of improvement of blood flow velocity in basilar arteries: the top three interventions were Dengzhanhuasu injection (97.6%) , Honghuahuangsesu injection (85.8%) , and Xingnaojing injection (80.6%) in combination with conventional western medicine; In terms of the improvement of whole blood high cut viscosity, the top three interventions were Shenmai injection (85.6%) , Danhong injection (80.0%) , and Shuxuetong injection (77.5%) in combination with conventional western drugs, respectively; In terms of the improvement of whole blood low cut viscosity, the top three interventions were Shuxuetong injection (90.3%) , Tianmasu injection (77.5%) , and Shenmai injection (73.0%) in combination with conventional western drugs, respectively. In terms of safety: no serious adverse drug reactions occurred in all studies.

Xingnaojing injection combined with conventional western medicine showed excellent clinical efficacy in improving PCIV vertigo symptoms and vertebral basilar artery blood flow velocity, which provided a certain reference for clinical medication, and the combination of traditional Chinese patent medicines and simple preparations injection and conventional western medicine was superior to conventional western medicine alone, and had good drug safety. However, the available evidence is limited by the quality and quantity of the included literature, and the above conclusions need to be further validated by more high-quality prospective RCT.

后循环缺血性眩晕（PCIV）常可作为脑梗死的先兆症状，具有反复发作、缠绵不愈等特点，严重影响患者生命质量，而常规的西医治疗临床疗效有限。目前中成药注射液在控制和缓解眩晕的发作方面具有显著疗效，但鉴于中成药制剂种类繁多，缺乏相关循证医学证据评估各种中成药注射液的优劣。

运用网状Meta分析对不同中成药注射液联合常规西药治疗PCIV的疗效和安全性进行评价。

全面检索中国知网、维普网、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Web of Science、Embase、Cochrane Library数据库建库至2024-05-07有关中成药注射液治疗PCIV的随机对照试验（RCT）。运用Cochrane风险偏倚工具对纳入文献进行质量评价，采用Stata 17.0、RevMan 5.4软件进行统计学分析。

最终纳入49项RCT，4 556例患者，涉及丹参川芎嗪注射液、丹红注射液、参芎葡萄糖注射液、参麦注射液、天麻素注射液、灯盏花素注射液、疏血通注射液、红花黄色素注射液、舒血宁注射液、苦碟子注射液、葛根素注射液、醒脑静注射液、银杏达莫注射液13种中成药注射液。网状Meta分析结果显示，眩晕症状改善[即眩晕障碍量表（DHI）评分]方面：累积排序概率图下面积（SUCRA）排名前3的干预措施为醒脑静注射液（87.2%）、参麦注射液（73.5%）、舒血宁注射液（59.6%）分别联合常规西药；临床总有效率方面：排名前3的干预措施为银杏达莫注射液（88.3%）、天麻素注射液（63.3%）、葛根素注射液（57.6%）分别联合常规西药；左、右椎动脉血流速度改善方面：排名前3的干预措施为醒脑静注射液（96.2%、99.2%）、灯盏花素注射液（90.2%、85.6%）、红花黄色素注射液（69.3%、79.4%）分别联合常规西药；基底动脉血流速度改善方面：排名前3的干预措施为灯盏花素注射液（97.6%）、红花黄色素注射液（85.8%）、醒脑静注射液（80.6%）分别联合常规西药；全血高切黏度改善方面：排名前3的干预措施为参麦注射液（85.6%）、丹红注射液（80.0%）、疏血通注射液（77.5%）分别联合常规西药；全血低切黏度改善方面：排名前3的干预措施为疏血通注射液（90.3%）、天麻素注射液（77.5%）、参麦注射液（73.0%）分别联合常规西药。安全性方面：所有研究未发生严重的服药不良反应。

醒脑静注射液联合常规西药治疗在改善PCIV眩晕症状、椎-基底动脉血流速度方面均表现出优异的临床疗效，给临床用药提供了一定参考性，且中成药注射液与常规西药的联合应用均优于单用常规西药，且具有良好的用药安全性。上述结论受限于当前相关研究的数量与质量，仍需更多高质量的RCT进一步验证。