本文關(guān)鍵詞： 腰椎間盤突出癥 單純灸法 隨機(jī)對照試驗(yàn) Meta分析　出處：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:運(yùn)用Meta分析對應(yīng)用單純灸法治療腰椎間盤突出癥患者的臨床療效及安全性進(jìn)行系統(tǒng)評價。材料與方法:計算機(jī)檢索Pubmed、Embase、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、相關(guān)期刊論文(CNKI)、中文期刊全文數(shù)據(jù)庫(VIP)、萬方數(shù)字化期刊全文數(shù)據(jù)庫(WANFANG DATA),檢索年限至2016年11月,納入運(yùn)用單純灸法治療腰椎間盤突出癥,對照組采用常規(guī)針刺、牽引推拿、中藥熏蒸、中成藥、西藥等其他手段治療的隨機(jī)對照試驗(yàn)為研究對象,由2名研究者通過閱讀文章題目和摘要,并結(jié)合全文,對文獻(xiàn)進(jìn)行資料提取,應(yīng)用Revman 5.3軟件對臨床療效與安全性進(jìn)行Meta分析。結(jié)果:本研究共納入文獻(xiàn)28篇,均為隨機(jī)對照試驗(yàn),共納入2429例患者,試驗(yàn)組1254例,予單純隔物灸治療;對照組1175例,予常規(guī)針刺、牽引推拿、中藥熏蒸、中成藥、西藥等其他手段治療,治療療程不限。納入所有原始研究均提及采用隨機(jī)方法,其中12篇文獻(xiàn)采用隨機(jī)數(shù)字表法,1篇文獻(xiàn)采用密閉信封分配隱藏,1篇文獻(xiàn)采用單盲設(shè)計,5篇文獻(xiàn)對于失訪/退出原因予以說明,納入研究的存在一定的選擇、實(shí)施以及測量偏倚。采用改良Jadad量表對納入的28篇原始研究進(jìn)行評價,其中高質(zhì)量文獻(xiàn)共計12篇,低質(zhì)量文獻(xiàn)共計16篇。所有文獻(xiàn)均對數(shù)據(jù)進(jìn)行統(tǒng)計處理。Meta分析結(jié)果顯示:單純灸法的臨床療效優(yōu)于對照組(RR=1.16,95%CI(1.11,1.21),P0.00001);在降低腰椎間盤突出癥患者隨訪復(fù)發(fā)情況明顯優(yōu)于對照組(RR=0.31,95%CI(0.16,0.62),P=0.0009);在減輕腰椎間盤突出癥患者VAS評分方面與對照組比較差異具有統(tǒng)計學(xué)意義(WMD=-1.17,95%CI(-1.56,-0.78),P0.00001);在增強(qiáng)腰椎間盤突出癥患者腰椎功能評分方面與對照組比較差異具有統(tǒng)計學(xué)意義(SMD=3.65,95%CI(2.43,4.88),P0.00001);在增強(qiáng)腰椎間盤突出癥患者M(jìn)-JOA評分方面與對照組比較差異具有統(tǒng)計學(xué)意義(WMD=2.31,95%CI(0.87,3.76),P=0.002);同時能夠降低腰椎間盤突出癥患者的血清IL-6含量(SMD=-0.62,95%CI(-0.98,-0.25),P=0.0010)。結(jié)論:單純灸法能夠有效減輕腰椎間盤突出癥患者的疼痛,改善臨床癥狀,降低隨訪復(fù)發(fā)情況,但本次納入的文獻(xiàn)質(zhì)量一般,本次分析仍具有一定的局限性,仍需進(jìn)一步進(jìn)行合理的多中心隨機(jī)雙盲對照實(shí)驗(yàn)進(jìn)行評價。
[Abstract]:Objective: to evaluate the efficacy and safety of moxibustion alone in the treatment of lumbar disc herniation by Meta. Materials and methods: Pubmedmedan Embase was searched by computer. China Biomedical Literature Database (CBM), China Journal Full-text Database (CNKI), Chinese Journal Full-text Database (VIP). Wanfang digital periodical full-text database WANFANG DATAA, the retrieval time to November 2016, included the treatment of lumbar disc herniation by moxibustion alone, the control group was treated with routine acupuncture. Traction massage, Chinese medicine fumigation, Chinese patent medicine, western medicine and other means of randomized controlled trials, by two researchers by reading the title and summary of the article, and combined with the full text of the literature data extraction. The clinical efficacy and safety were analyzed by Meta with Revman 5.3 software. Results: 28 articles were included in this study, all of them were randomized controlled trials, and 2 429 patients were included in this study. In the experimental group, 1254 cases were treated with moxibustion only. In the control group, 1175 cases were treated with routine acupuncture, traction massage, traditional Chinese medicine fumigation, Chinese patent medicine, western medicine, etc. The course of treatment was unlimited. Among them, 12 articles were randomly listed and 1 document was allocated and hidden by closed envelopes. One document was designed with a single blind design and 5 articles were used to explain the reasons for the loss or withdrawal of the interview. The selection, implementation and measurement of bias in the inclusion study were evaluated with the modified Jadad scale for 28 original studies, of which 12 were of high quality. The results of statistical analysis showed that the clinical effect of moxibustion alone was better than that of control group (RRX 1.16). 95. CII 1.11, 1.21, P0.00001; In the patients with lumbar disc herniation, the rate of follow-up and recurrence was significantly better than that of the control group. Compared with the control group, the VAS score of the patients with lumbar disc herniation was significantly different from that of the control group (WMD-1.1795). P0.00001; Compared with the control group, there was a significant difference in the enhancement of lumbar function score between the patients with lumbar disc herniation and the control group (SMD3.65 / 95 CI 2.43 / 4.88). P0.00001; Compared with the control group, the M-JOA score of the patients with lumbar disc herniation was significantly higher than that of the control group (WMD2.31 / 95CI0.87 / 3.76). P0. 002; At the same time, it can reduce the serum IL-6 content of patients with lumbar disc herniation. Conclusion: moxibustion alone can effectively reduce pain, improve clinical symptoms and reduce recurrence in patients with lumbar disc herniation, but the quality of literature included in this study is general. This analysis still has some limitations, and needs to be further evaluated by multi-center randomized double-blind controlled trial.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.9

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