針灸治療中風后痙攣性癱瘓的系統(tǒng)評價與Meta分析
發(fā)布時間：2018-10-16 19:36
【摘要】：目的通過對國內(nèi)外發(fā)表的針灸治療中風后痙攣性癱瘓的隨機對照試驗(RCT)進行系統(tǒng)評價與Meta分析,確定中風后痙攣性癱瘓患者使用針灸治療的有效性和安全性,為今后的臨床治療提供循證醫(yī)學證據(jù)。方法電子檢索中國知網(wǎng)期刊全文數(shù)據(jù)庫(CNKI,1994～2017.02);中國生物醫(yī)學文獻光盤數(shù)據(jù)庫(CBM,1979～2017.02);維普數(shù)據(jù)庫(VIP Date,1989～2017.02);萬方數(shù)據(jù)庫(Wan-Fang Data,1999～2017.02)MEDLINE(1966～2017.02);EMBASE(1980～2017.02);Cochrane Central Register of Controlled Trials(2017年第2期)。選擇針灸治療腦卒中導致的肢體痙攣性癱瘓的隨機對照試驗,進行收集、提取、交叉檢查并分析數(shù)據(jù)。結(jié)果根據(jù)納入排除標準,最終納入33項隨機對照試驗,患者總數(shù)為2970人。其中1項試驗在德國完成,其余均在中國完成。2篇研究采用針灸與安慰針進行比較,9篇研究采用針灸與康復治療進行比較,19篇研究采用針刺聯(lián)合康復治療與單獨康復治療進行比較,1篇研究采用針灸聯(lián)合中藥靜脈注射與單獨中藥靜脈注射進行比較,2篇研究采用針灸聯(lián)合中藥熏蒸與單獨中藥熏蒸進行比較。根據(jù)Cochrane偏倚風險評估標準,大部分試驗的方法學質(zhì)量普遍不高,證據(jù)質(zhì)量低,且存在發(fā)表偏倚。Meta分析結(jié)果顯示:①與安慰針比較,針刺對改良Ashworth評分的臨床改善無統(tǒng)計學差異(MD=-0.33,95%CI:-1.12～0.47)。②與康復治療比較,針灸的有效率高于康復治療(RR=1.22,95%CI:1.07～1.40);Fugl-Meyer評分的改善優(yōu)于康復治療(MD=10.66,95%CI:3.63～17.70);Barthel指數(shù)的改善優(yōu)于康復治療(MD=14.84,95%CI:1.10～28.59);改良Ashworth評分的改善優(yōu)于康復治療(MD=-0.52,95%CI:-0.73～-0.32)。③與單獨進行康復治療比較,針灸聯(lián)合康復治療的有效率高于單獨的康復治療(RR=1.23,95%CI:1.17～1.29);Fugl-Meyer評分的改善優(yōu)于單獨康復治療(MD=12.24,95%CI:7.24～17.24);Barthel指數(shù)的改善優(yōu)于單獨康復治療(MD=11.84,95%CI:7.80～15.88);改良Ashworth評分的改善優(yōu)于單獨康復治療(MD=-0.41,95%CI:-0.59～-0.24);NDS評分的改善優(yōu)于單獨康復治療(MD=-4.47,95%CI:-5.58～-3.36)。④與中藥靜脈注射比較,針刺聯(lián)合中藥靜脈注射的有效率高于單獨的中藥靜脈注射(RR=2.00,95%CI:1.33～3.01)。⑤與中藥熏蒸比較,針刺聯(lián)合中藥熏蒸的有效率高于單獨的中藥熏蒸(RR=1.22,95%CI:1.05～1.41);Fugl-Meyer評分的改善優(yōu)于單獨中藥熏蒸(MD=8.07,95%CI:2.40～13.74);改良Ashworth評分與單獨中藥熏蒸臨床改善無統(tǒng)計學差異(MD=0.09,95%CI:-1.06～1.23)。對于安全性的報道,僅有1篇研究描述了針刺后針孔處出血的輕微的不良事件,說明針灸治療中風后痙攣性癱瘓是安全的。結(jié)論從現(xiàn)有證據(jù)可以看出,針灸治療有助于改善中風后痙攣性癱瘓患者的運動功能恢復、提高患者日常生活能力、改善神經(jīng)系統(tǒng)功能缺損;而在緩解患者肢體痙攣程度方面,針灸療效的結(jié)論不一致。此外,針灸在近期治療中沒有明顯嚴重的不良事件,安全性高。然而,針灸治療的遠期療效和安全性未知;且大多數(shù)納入的試驗證據(jù)質(zhì)量不高,樣本量小,整體方法學質(zhì)量不佳,高偏倚風險較多。迄今為止的證據(jù)不足以得出針灸對中風后痙攣性癱瘓療效的明確結(jié)論。建議在以后的研究中,應多進行大樣本、多中心、高質(zhì)量的隨機對照試驗,且增加隨訪觀察以進一步明確針灸治療的遠期療效和安全性。
[Abstract]:Objective To evaluate the efficacy and safety of acupuncture therapy in patients with cerebral palsy after stroke and provide evidence-based medical evidence for future clinical treatment. Method electronically retrieves the full-text database of Chinese known web journals (CNKI, 1994 ~ 2017 02); China Biomedical Literature CD Database (CBM, 1979 ~ 2017 02); Vip database (VIP Date, 1989 ~ 2017 02); Wanfang database (Wan-Chang Data, 1999 ~ 2017. 02) MEDLINE (1966 ~ 2017 02); EMBASE (1980 ~ 2017. 02); Cochrane Central Register of Controlled Trials (Phase 2 of 2017). The randomized controlled trial of acupuncture and moxibustion in the treatment of cerebral palsy caused by stroke was selected, and data were collected, extracted, cross-examined and analyzed. Results According to the inclusion exclusion criteria, 33 randomized controlled trials were included and the total number of patients was 2970. One of the tests was completed in Germany, The rest were done in China. The two studies were compared with the comfort needle by acupuncture and moxibustion. Nine studies were compared with the treatment of acupuncture and rehabilitation. 19 studies were compared with the treatment of acupuncture combined with rehabilitation therapy. One study combined with acupuncture combined with traditional Chinese medicine intravenous injection and single traditional Chinese medicine vein injection. A comparison was made, and two studies were compared with fumigation of traditional Chinese medicine fumigation using acupuncture combined with traditional Chinese medicine fumigation. According to Cochrane bias risk assessment criteria, most of the trials have a generally high methodological quality, low evidence quality, and there is a bias. Meta-analysis showed that acupuncture had no statistical difference (MD =-0.033, 95% CI:-1.12 ~ 0. 47) compared with placebo. Compared with rehabilitation therapy, the effective rate of acupuncture was higher than rehabilitation therapy (RR = 1. 22, 95% CI: 1. 07 ~ 1. 40). The improvement of Fugl-Meyer score was better than rehabilitation therapy (MD = 10.66, 95% CI: 3.63 ~ 17. 70); the improvement of Barthel index was better than rehabilitation therapy (MD = 14.84, 95% CI: 1. 10 ~ 28. 59); the improvement of the modified Ashton score was better than rehabilitation therapy (MD =-0.052, 95% CI:-0.73 ~-0. 32). The effective rate of acupuncture combined with rehabilitation therapy was higher than that of individual rehabilitation therapy (RR = 1. 23, 95% CI: 1. 17 ~ 1. 29). The improvement of Fugl-Meyer score was better than that of individual rehabilitation therapy (MD = 12. 24, 95% CI: 7. 24 ~ 17. 24); the improvement of Barthel index was better than treatment alone (MD = 11. 84, 95% CI: 7. 80 ~ 15. 88). The improvement of the improved Ashton score was better than the individual rehabilitation therapy (MD =-0.41, 95% CI:-0.59 ~-0.24); the improvement of the NDS score was better than the alone rehabilitation therapy (MD =-4.47, 95% CI:-5.58 ~-3.36). Compared with traditional Chinese medicine intravenous injection, the effective rate of acupuncture combined with traditional Chinese medicine injection was higher than that of single Chinese medicine intravenous injection (RR = 2.00, 95% CI: 1.33 ~ 3.01). Compared with traditional Chinese medicine fumigation, the effective rate of acupuncture combined with traditional Chinese medicine fumigation was higher than that of single traditional Chinese medicine fumigation (RR = 1. 22, 95% CI: 1. 05 ~ 1. 41); the improvement of Fugl-Meyer score was better than that of single traditional Chinese medicine fumigation (MD = 8.07, 95% CI: 2.40 ~ 13.74); the improvement of Ashton score was not statistically significant (MD = 0.009, 95% CI:-1.06 ~ 1.23). For safety reports, only one study describes a minor adverse event of bleeding at the post-acupuncture needle-hole, suggesting that acupuncture and moxibustion treatment of post-stroke cerebral palsy is safe. Conclusion It can be seen from the existing evidence that acupuncture therapy can improve the recovery of motor function in patients with cerebral palsy after stroke, improve the ability of daily life of patients, improve the functional defect of nervous system, and do not agree with the conclusion of the curative effect of acupuncture and moxibustion in relieving the degree of limb spasm of patients. In addition, acupuncture has no obvious serious adverse event in recent treatment, and has high safety. However, the long-term efficacy and safety of acupuncture treatment are unknown; and most of the included trial evidence is not high in quality, small in sample size, poor in overall methodology quality and high in high bias risk. The evidence to date is not enough to draw clear conclusions about the efficacy of acupuncture on post-stroke cerebral palsy. It is suggested that in future studies, large sample, multi-center, high-quality randomized controlled trials should be performed and follow-up observations are added to further clarify the long-term efficacy and safety of acupuncture treatment.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6
本文編號：2275417
[Abstract]:Objective To evaluate the efficacy and safety of acupuncture therapy in patients with cerebral palsy after stroke and provide evidence-based medical evidence for future clinical treatment. Method electronically retrieves the full-text database of Chinese known web journals (CNKI, 1994 ~ 2017 02); China Biomedical Literature CD Database (CBM, 1979 ~ 2017 02); Vip database (VIP Date, 1989 ~ 2017 02); Wanfang database (Wan-Chang Data, 1999 ~ 2017. 02) MEDLINE (1966 ~ 2017 02); EMBASE (1980 ~ 2017. 02); Cochrane Central Register of Controlled Trials (Phase 2 of 2017). The randomized controlled trial of acupuncture and moxibustion in the treatment of cerebral palsy caused by stroke was selected, and data were collected, extracted, cross-examined and analyzed. Results According to the inclusion exclusion criteria, 33 randomized controlled trials were included and the total number of patients was 2970. One of the tests was completed in Germany, The rest were done in China. The two studies were compared with the comfort needle by acupuncture and moxibustion. Nine studies were compared with the treatment of acupuncture and rehabilitation. 19 studies were compared with the treatment of acupuncture combined with rehabilitation therapy. One study combined with acupuncture combined with traditional Chinese medicine intravenous injection and single traditional Chinese medicine vein injection. A comparison was made, and two studies were compared with fumigation of traditional Chinese medicine fumigation using acupuncture combined with traditional Chinese medicine fumigation. According to Cochrane bias risk assessment criteria, most of the trials have a generally high methodological quality, low evidence quality, and there is a bias. Meta-analysis showed that acupuncture had no statistical difference (MD =-0.033, 95% CI:-1.12 ~ 0. 47) compared with placebo. Compared with rehabilitation therapy, the effective rate of acupuncture was higher than rehabilitation therapy (RR = 1. 22, 95% CI: 1. 07 ~ 1. 40). The improvement of Fugl-Meyer score was better than rehabilitation therapy (MD = 10.66, 95% CI: 3.63 ~ 17. 70); the improvement of Barthel index was better than rehabilitation therapy (MD = 14.84, 95% CI: 1. 10 ~ 28. 59); the improvement of the modified Ashton score was better than rehabilitation therapy (MD =-0.052, 95% CI:-0.73 ~-0. 32). The effective rate of acupuncture combined with rehabilitation therapy was higher than that of individual rehabilitation therapy (RR = 1. 23, 95% CI: 1. 17 ~ 1. 29). The improvement of Fugl-Meyer score was better than that of individual rehabilitation therapy (MD = 12. 24, 95% CI: 7. 24 ~ 17. 24); the improvement of Barthel index was better than treatment alone (MD = 11. 84, 95% CI: 7. 80 ~ 15. 88). The improvement of the improved Ashton score was better than the individual rehabilitation therapy (MD =-0.41, 95% CI:-0.59 ~-0.24); the improvement of the NDS score was better than the alone rehabilitation therapy (MD =-4.47, 95% CI:-5.58 ~-3.36). Compared with traditional Chinese medicine intravenous injection, the effective rate of acupuncture combined with traditional Chinese medicine injection was higher than that of single Chinese medicine intravenous injection (RR = 2.00, 95% CI: 1.33 ~ 3.01). Compared with traditional Chinese medicine fumigation, the effective rate of acupuncture combined with traditional Chinese medicine fumigation was higher than that of single traditional Chinese medicine fumigation (RR = 1. 22, 95% CI: 1. 05 ~ 1. 41); the improvement of Fugl-Meyer score was better than that of single traditional Chinese medicine fumigation (MD = 8.07, 95% CI: 2.40 ~ 13.74); the improvement of Ashton score was not statistically significant (MD = 0.009, 95% CI:-1.06 ~ 1.23). For safety reports, only one study describes a minor adverse event of bleeding at the post-acupuncture needle-hole, suggesting that acupuncture and moxibustion treatment of post-stroke cerebral palsy is safe. Conclusion It can be seen from the existing evidence that acupuncture therapy can improve the recovery of motor function in patients with cerebral palsy after stroke, improve the ability of daily life of patients, improve the functional defect of nervous system, and do not agree with the conclusion of the curative effect of acupuncture and moxibustion in relieving the degree of limb spasm of patients. In addition, acupuncture has no obvious serious adverse event in recent treatment, and has high safety. However, the long-term efficacy and safety of acupuncture treatment are unknown; and most of the included trial evidence is not high in quality, small in sample size, poor in overall methodology quality and high in high bias risk. The evidence to date is not enough to draw clear conclusions about the efficacy of acupuncture on post-stroke cerebral palsy. It is suggested that in future studies, large sample, multi-center, high-quality randomized controlled trials should be performed and follow-up observations are added to further clarify the long-term efficacy and safety of acupuncture treatment.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6
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