电针治疗中风后肩手综合征的系统评价与Meta分析

发布时间：2018-03-11 21:34

本文选题：电针　切入点：中风　出处：《黑龙江中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:运用循证医学的方法对电针治疗中风后肩手综合征的有效性进行评价,为电针治疗中风后肩手综合征的临床运用提供循证医学依据。通过对随机对照临床试验的归纳与系统研究,总结电针的选穴规律及相关参数的影响因素,以提高针灸临床研究的质量。方法:参照Cochrane系统评价手册5.1.0版,制定电子检索策略,检索中国知网(CNKI,2005.1.1-2016.12.31)、维普数据库(VIP,2005.1.1-2016.12.31)、万方数据库(WF,2005.1.1-2016.12.31)、中国生物医学数据库(CBM,2005.1.1-2016.12.31)、考克兰图书馆(Cochrane library,2005.1.1-2016.12.31)、美国国立医学图书馆生物医学信息数据库(Pubmed,2005.1.1-2016.12.31)中有关电针治疗中风后肩手综合征的文献。运用EndnoteX7文献管理软件导入文献,严格筛查筛选与提取文献。采用Jadad量表及Cochrane5.1.0系统评价手册中的风险偏倚评估工具对文献进行质量评估。采用RevMan5.3软件对纳入研究的总有效率、主症积分进行Meta分析。结果:1.通过电子检索共获得229篇电针治疗中风后肩手综合征的RCT研究的文献,本次研究仅纳入符合标准的16篇RCT研究,占总文献量的6.98%,共1434例患者。改良Jadad评分显示:3篇文献为高质量文献,13篇为低质量文献。Cochrane风险评估偏倚评估结果显示:1篇为高度偏倚风险文献,15篇为偏倚风险不确定文献。2.电针结合康复训练对比康复训练:①电针结合康复治疗总有效率优于康复组。RR=1.22,95%CI[1.13,1.31]②电针结合康复训练在改善中风后肩手综合征的上肢运动功能方面即提高Fugel-Meyer评分优于常规康复。MD=8.27,95%CI[5.76,10.78]。③电针结合康复训练治疗在改善视觉模拟评分量表VAS评分的疗效与常规康复训练临床差异不大。MD=-1.26,95%CI[-3.01,0.49]④电针结合康复训练在改善中风后肩手综合征的日常生活活动能力方面即ADL评分优于常规康复训练。MD=9.074并且95%CI[7.65,10.49]。3.电针对比康复训练:①电针治疗总有效率明显优于康复治疗,RR=1.15并且95%CI[1.04,1.27]②电针在改善上肢运动功能方面可能与常规康复训练差别不大。MD =3.79,95%CI[-3.35,10.92]。③电针治疗在改善视觉模拟评分量表VAS评分的疗效可能优于常规康复训练。MD=-1.44,95%CI[-2.35,-0.52]。④电针组在改善中风后肩手综合征的日常生活活动能力方面即ADL评分疗效显著优于康复治疗。MD=-1.23并95%CI[-2.02,-0.44]。4.电针对比毫针:①电针治疗总有效率优于毫针治疗,RR=1.11并且95%CI[1.05,1.18]。②电针治疗在手背水肿消退率方面疗效优于毫针RR=1.32,95%CI[1.19,1.46]③电针治疗在被动屈曲手痛痛止率方面疗效优于毫针 RR=1.31 并且 95%CI[1.18,1.45]。结论:1、本系统评价肯定了电针治疗中风后肩手综合征的有效性,在改善上肢运动功能、止痛消肿、提高日常生活活动能力方面疗效显著。2、本系统评价纳入的临床研究文献整体质量不高,希望以后有更多高质量的临床随机对照试验为电针治疗中风后肩手综合征的临床疗效及电针参数的深入研究提供依据。
[Abstract]:Objective: using the method of evidence-based medicine to evaluate the effectiveness of shoulder hand syndrome after stroke by acupuncture treatment, provide a basis for clinical application of shoulder hand syndrome after stroke. Acupuncture treatment based on induction and systematic study of randomized controlled clinical trials, factors affecting the rule of point selection and summary of related parameters of electroacupuncture in order to improve the quality of clinical research of acupuncture and moxibustion. Methods: according to Cochrane systematic manual 5.1.0 version, making electronic search strategies, search China HowNet (CNKI, 2005.1.1-2016.12.31), VIP database (VIP, 2005.1.1-2016.12.31), Wanfang database (WF, 2005.1.1-2016.12.31), Chinese biomedical databases (CBM, 2005.1.1-2016.12.31, Cochrane Library (Cochrane) library, 2005.1.1-2016.12.31), biomedical information database of the National Library of Medicine (Pubmed, 2005.1.1-2016.12.31) in the treatment of stroke The shoulder hand syndrome after literature. By using the EndnoteX7 document management software import documents, strict screening and extraction of literature. To evaluate the quality of the manual Jadad scale and Cochrane5.1.0 system in the evaluation tool for assessing the risk of bias. Using RevMan5.3 software to study the total efficiency, the main points of disease were analyzed. Results: Meta 1. through electronic searches received a total of 229 RCT of shoulder - hand syndrome after stroke acupuncture literature, this study included only 16 articles on RCT standard, accounting for 6.98% of the total amount of the literature, a total of 1434 cases of patients. The modified Jadad score: 3 references for high quality literature, 13 articles were low the quality of.Cochrane risk assessment bias evaluation results showed that 1 is a high risk of bias of literature, 15 articles for the uncertain risk of bias in.2. electro acupuncture combined with rehabilitation training compared with rehabilitation training: electro acupuncture combined with rehabilitation Treatment of the total efficiency is better than the rehabilitation group.RR=1.22,95%CI[1.13,1.31] electro acupuncture combined with rehabilitation training in improving the motor function of upper limbs after stroke shoulder hand syndrome, improve Fugel-Meyer score than the conventional rehabilitation and acupuncture combined with rehabilitation training in the treatment of.MD=8.27,95%CI[5.76,10.78]. in improving the visual analogue scale VAS score efficacy and routine rehabilitation training clinical difference.MD=-1.26,95%CI[-3.01,0.49] the electroacupuncture combined with rehabilitation training to improve the ability of daily life after stroke shoulder hand syndrome, ADL score is better than that of the conventional rehabilitation training of.MD=9.074 and 95% CI[7.65,10.49].3. electroacupuncture acupuncture rehabilitation training: comparison of the total efficiency of treatment was significantly better than rehabilitation treatment, RR=1.15 and 95%CI[1.04,1.27] in electro acupuncture could improve the motor function of upper limb is not very different from the conventional rehabilitation training.MD =3.79,95%CI[-3.35,10.92]. 3 electric Acupuncture therapy to improve the visual analogue scale VAS score efficacy may be superior to conventional rehabilitation training of.MD=-1.44,95%CI[-2.35, -0.52]. and electro acupuncture group in improving the ability of activities of daily living of shoulder hand syndrome after stroke is ADL score efficacy is significantly better than the rehabilitation treatment of.MD=-1.23 and 95%CI[-2.02, -0.44].4. contrast: Electroacupuncture electroacupuncture acupuncture has better effect than acupuncture treatment of RR=1.11 and 95%CI[1.05,1.18]., the extinction rate of acupuncture treatment has better effect than the RR=1.32,95%CI[1.19,1.46] needle electroacupuncture treatment rate in passive flexion hand pain pain curative effect is better than that of RR=1.31 and 95%CI[1.18,1.45]. in the back of the hand needle conclusion edema: 1, affirmed the validity of shoulder hand syndrome after stroke electroacupuncture treatment of this evaluation system, to improve the motor function of upper limb, relieve pain, improve the ability of daily life in effect is significant.2, this evaluation system is satisfied The overall quality of the clinical research literature is not high. We hope that there will be more high-quality clinical randomized controlled trials in the future to provide evidence for the clinical efficacy of electroacupuncture for the treatment of shoulder hand syndrome after stroke and the in-depth study of Electroacupuncture Parameters.

【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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