针灸治疗中风后痉挛性瘫痪的系统评价与Meta分析
发布时间：2018-10-16 19:36
【摘要】：目的通过对国内外发表的针灸治疗中风后痉挛性瘫痪的随机对照试验(RCT)进行系统评价与Meta分析,确定中风后痉挛性瘫痪患者使用针灸治疗的有效性和安全性,为今后的临床治疗提供循证医学证据。方法电子检索中国知网期刊全文数据库(CNKI,1994～2017.02);中国生物医学文献光盘数据库(CBM,1979～2017.02);维普数据库(VIP Date,1989～2017.02);万方数据库(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)。选择针灸治疗脑卒中导致的肢体痉挛性瘫痪的随机对照试验,进行收集、提取、交叉检查并分析数据。结果根据纳入排除标准,最终纳入33项随机对照试验,患者总数为2970人。其中1项试验在德国完成,其余均在中国完成。2篇研究采用针灸与安慰针进行比较,9篇研究采用针灸与康复治疗进行比较,19篇研究采用针刺联合康复治疗与单独康复治疗进行比较,1篇研究采用针灸联合中药静脉注射与单独中药静脉注射进行比较,2篇研究采用针灸联合中药熏蒸与单独中药熏蒸进行比较。根据Cochrane偏倚风险评估标准,大部分试验的方法学质量普遍不高,证据质量低,且存在发表偏倚。Meta分析结果显示:①与安慰针比较,针刺对改良Ashworth评分的临床改善无统计学差异(MD=-0.33,95%CI:-1.12～0.47)。②与康复治疗比较,针灸的有效率高于康复治疗(RR=1.22,95%CI:1.07～1.40);Fugl-Meyer评分的改善优于康复治疗(MD=10.66,95%CI:3.63～17.70);Barthel指数的改善优于康复治疗(MD=14.84,95%CI:1.10～28.59);改良Ashworth评分的改善优于康复治疗(MD=-0.52,95%CI:-0.73～-0.32)。③与单独进行康复治疗比较,针灸联合康复治疗的有效率高于单独的康复治疗(RR=1.23,95%CI:1.17～1.29);Fugl-Meyer评分的改善优于单独康复治疗(MD=12.24,95%CI:7.24～17.24);Barthel指数的改善优于单独康复治疗(MD=11.84,95%CI:7.80～15.88);改良Ashworth评分的改善优于单独康复治疗(MD=-0.41,95%CI:-0.59～-0.24);NDS评分的改善优于单独康复治疗(MD=-4.47,95%CI:-5.58～-3.36)。④与中药静脉注射比较,针刺联合中药静脉注射的有效率高于单独的中药静脉注射(RR=2.00,95%CI:1.33～3.01)。⑤与中药熏蒸比较,针刺联合中药熏蒸的有效率高于单独的中药熏蒸(RR=1.22,95%CI:1.05～1.41);Fugl-Meyer评分的改善优于单独中药熏蒸(MD=8.07,95%CI:2.40～13.74);改良Ashworth评分与单独中药熏蒸临床改善无统计学差异(MD=0.09,95%CI:-1.06～1.23)。对于安全性的报道,仅有1篇研究描述了针刺后针孔处出血的轻微的不良事件,说明针灸治疗中风后痉挛性瘫痪是安全的。结论从现有证据可以看出,针灸治疗有助于改善中风后痉挛性瘫痪患者的运动功能恢复、提高患者日常生活能力、改善神经系统功能缺损;而在缓解患者肢体痉挛程度方面,针灸疗效的结论不一致。此外,针灸在近期治疗中没有明显严重的不良事件,安全性高。然而,针灸治疗的远期疗效和安全性未知;且大多数纳入的试验证据质量不高,样本量小,整体方法学质量不佳,高偏倚风险较多。迄今为止的证据不足以得出针灸对中风后痉挛性瘫痪疗效的明确结论。建议在以后的研究中,应多进行大样本、多中心、高质量的随机对照试验,且增加随访观察以进一步明确针灸治疗的远期疗效和安全性。
[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.
【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
本文编号：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.
【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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