基于随机对照试验的针灸疗法治疗高血压的Meta分析

发布时间：2018-01-15 13:46

本文关键词：基于随机对照试验的针灸疗法治疗高血压的Meta分析　出处：《山东中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:收集各数据库起始年限起国内外所有已发表的针灸疗法治疗高血压的中英文随机对照研究,应用系统评价方法评价其疗效和安全性。并且基于现有文献,评价针灸疗法治疗高血压的证据水平,为撰写指南提供证据。资料和方法:根据系统评价要求,采取电子检索与手工检索相结合的方式全面检索中英文数据库。参考纳入标准进行文献初筛和资料提取,然后对所纳入的研究进行文献质量评价和资料合成,由两名独立的研究人员从随机分配方案产生、方案隐藏、盲法、数据的完整性和选择性报告等方面对纳入文献的质量进行评价。并分别采用血压降低数值、降压有效率及证候改善情况作为主要结局指标评价针灸疗法的降压疗效。采用协作网提供的软件进行统计学分析。结果:共检出文献4092篇,其中重复文献277篇,通过阅读题目和摘要进行初筛,剔除3558篇,通过阅读全文,剔除非随机对照研究48篇,半随机研究剔除48篇,因研究结果数据不全剔除57篇,因主要结局指标剔除39篇,重复发表14篇。最终纳入15个临床试验。数据提取后,进行分析或描述性分析。结果显示一种针灸疗法和两种针灸疗法联用与西药相比在血压值、动态血压、降压的有效率、证候疗效的有效率和中医证候积分方面有统计学差异;针灸疗法联合西药与单独应用西药相比在血压值、证候疗效、中医证候评分方面有统计学差异,但一种针灸疗法联合西药在降压的有效率方面没有统计学差异。结论:本研究表明,单一针灸疗法和两种针灸疗法联用在血压值、动态血压、降压的有效率、证候疗效的有效率和中医证候评分方面有优势;针灸疗法联合西药在血压值、证候疗效、中医证候评分方面表现出一定优势,但一种针灸疗法联合西药在降压的有效率方面没有优势。治疗期间也未发现有明显的不良反应。针灸疗法治疗高血压临床试验的方法学质量普遍偏低,且未实施高水平的随机分配,缺乏合理的对照措施(安慰剂效应不明确)。因此开展高质量、大样本、多中心、随机双盲对照试验来进一步证实以上结果的稳定性和准确性是有必要的。本研究的文献为病例对照研究,有一定证据证明针灸疗法可以降低血压和改善症状,但不够充分,故证据等级为IIb级,推荐强度为选择性推荐。
[Abstract]:Objective: to collect all published Chinese and English randomized controlled studies of acupuncture and moxibustion therapy for hypertension from the beginning years of each database, and to evaluate the efficacy and safety of acupuncture therapy with systematic evaluation method. To evaluate the evidence level of acupuncture and moxibustion therapy in the treatment of hypertension, and to provide evidence for the preparation of guidelines. Information and methods: according to the requirements of systematic evaluation. The electronic retrieval and manual retrieval were adopted to search the Chinese and English databases. The reference inclusion criteria were used to screen and extract the documents, and then the literature quality evaluation and data synthesis were carried out. The quality of the literature was evaluated by two independent researchers from random allocation schemes, scheme concealment, blind methods, data integrity and selective reporting. The effective rate of hypotension and the improvement of syndromes were used as the main outcome indicators to evaluate the antihypertensive effect of acupuncture and moxibustion therapy. Among them, 277 articles were repeated, 3558 articles were eliminated by reading title and abstract, 48 articles were eliminated by reading full text, 48 articles were eliminated by semi-random study. 57 articles were excluded because of incomplete data, 39 articles were eliminated because of the main outcome index, and 14 articles were published repeatedly. Finally, they were included in 15 clinical trials. The data were extracted. Analysis or descriptive analysis. The results showed that one acupuncture therapy combined with two acupuncture and moxibustion therapy was effective in blood pressure, ambulatory blood pressure and hypotension compared with western medicine. The effective rate of syndromes was significantly different from that of TCM syndromes. Acupuncture and moxibustion combined with western medicine compared with the use of western medicine alone in blood pressure, syndromes efficacy, TCM syndromes score has statistical differences. However, there is no statistical difference in the effective rate of lowering blood pressure between one kind of acupuncture and moxibustion combined with western medicine. Conclusion: this study shows that single acupuncture and two kinds of acupuncture and moxibustion combined in blood pressure value, ambulatory blood pressure, effective rate of lowering blood pressure. The effective rate of syndromes and TCM syndromes score have advantages; Acupuncture and moxibustion combined with western medicine in blood pressure, syndromes efficacy, TCM syndromes score showed certain advantages. However, a combination of acupuncture and moxibustion combined with western medicine has no advantage in the effective rate of lowering blood pressure. There are no obvious adverse reactions during the treatment. The methodological quality of clinical trials of acupuncture and moxibustion in treating hypertension is generally low. There was no high level of random distribution and a lack of reasonable control (placebo effect was unclear). Therefore, high quality, large samples, and multiple centers were carried out. It is necessary to further confirm the stability and accuracy of the above results in a randomized double-blind controlled trial. The literature of this study is a case-control study, there is some evidence that acupuncture can reduce blood pressure and improve symptoms. But it is not enough, so the evidence level is IIb level and the recommended strength is selective recommendation.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.1

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