针刺预防性治疗偏头痛的系统评价与选穴配伍规律的研究

发布时间：2018-01-21 05:16

本文关键词： 针刺预防偏头痛系统评价关联分析　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:运用循证医学系统评价的方法对针刺预防性治疗偏头痛的有效性和安全性进行评价;研究针刺预防性治疗偏头痛的选穴配伍规律。方法:根据Cochrane系统评价员手册5.1.0制定文献的纳入与排除标准及检索策略;对纳入文献进行方法学质量评价;使用Revman5.3软件对纳入文献进行有效性及安全性评价的定量分析,采用有效率、每月偏头痛发作天数、每月偏头痛发作次数、偏头痛疼痛程度、止痛药物使用次数、每次偏头痛平均持续时间、PDI、MIDAS、SF-36或SF-12作为结局指标分别从0-1个月、1-2个月、3-4个月、5-6个月及6个月以上5个时间对有效性进行评价,采用不良反应人数作为结局指标对安全性进行评价。计数资料采用相对危险度(Relative Risk,RR)及其95%的可信区间(Confidence interval,CI);计量资料采用标准化均数差值(Standardized mean difference,SMD)及其95%可信区间;对不能进行定量分析的指标进行定性分析。使用Access2013建立纳入文献选穴使用表,并使用SPSS Modeler14.1软件对纳入文献资料进行选穴配伍规律的关联分析。结果:1.共检索到文献572篇,最终纳入26个符合纳入标准的研究文献,其中英文文献15篇,中文文献11篇(含学位论文4篇),共计纳入受试者3657人。2.以对照组干预措施和时间段分亚组后,针刺与空白对照共计18个指标有研究纳入;与假针刺对照共计38个指标有研究纳入;与西药对照共计34个指标有研究纳入。3.Meta分析结果显示:与空白组对比,针刺预防性治疗偏头痛14个指标显示有效,4个指标无明显统计学差异;与假针刺对比,7个指标针刺有效,2个指标假针刺有效,其他29个指标无明显统计学差异;与西药对比,22个指标有效且安全性更高,12个指标无明显统计学差异。4.针刺预防性治疗偏头痛选用最多的3个穴位为风池、率谷、太阳;共产生82条关联规则,其中较为重要的规则有率谷→风池、太阳→风池、太冲→风池、太阳+率谷→风池、三阴交+风池→太阳、三阴交+太阳→率谷、三阴交+太阳+率谷→风池、太冲+率谷+风池→太阳。结论:1.现有证据表明针刺预防性治疗偏头痛比空白对照有效,最差与西药疗效相当且安全性更高。不足以证明与假针刺有疗效差异。2.针刺预防性治疗偏头痛最常用的穴位为风池、率谷、太阳,常与三阴交、太冲联合使用。
[Abstract]:Objective: to evaluate the efficacy and safety of acupuncture in preventive treatment of migraine with the method of evidence-based medicine system evaluation. Methods: according to the Cochrane systematic evaluator's manual 5.1.0, the inclusion and exclusion criteria and retrieval strategy of the literature were formulated. Methodological quality evaluation of the literature included; Revman5.3 software was used to evaluate the efficacy and safety of the literature. The effective rate, the number of migraine attacks per month, the number of migraine attacks per month, and the degree of migraine pain were used. The average duration of each migraine was as follows: PDI MIDASS SF-36 or SF-12 were used as outcome indicators from 0-1 month to 1-2 months to 3-4 months, respectively. The effectiveness was evaluated for 5-6 months and more than 6 months. The safety was evaluated by the number of adverse reactions as the outcome index and the relative risk Risk was used to count the data. RR) and its confidence interval of 95%; The measured data were standardized mean difference (SD) and its 95% confidence interval. Qualitative analysis was carried out on the indexes which could not be quantitatively analyzed. Access2013 was used to set up the table of the use of the selected acupoints in the literature. SPSS Modeler14.1 software was used to analyze the law of acupoint compatibility. Results: 1. A total of 572 articles were retrieved. Finally, 26 research papers were included, of which 15 were in Chinese and English and 11 in Chinese (including 4 dissertations). A total of 3657 subjects were included. 2. After the intervention measures of control group and time period were divided into subgroups, 18 indexes of acupuncture and blank control were included in the study. A total of 38 indexes compared with pseudoacupuncture were included in the study. The results of meta-analysis showed that 14 indexes of acupuncture preventive treatment for migraine were effective compared with the blank group. There was no significant statistical difference among the four indexes. Compared with sham acupuncture, 7 indexes were effective, 2 indexes were effective, and the other 29 indexes had no significant difference. Compared with western medicine, 22 indexes were effective and the safety was higher. There was no significant difference in 12 indexes. 4. The three points of acupuncture preventive treatment for migraine were wind pond, rate valley and sun. A total of 82 association rules were generated, among which the more important ones were the rate Valley. 鈫扺ind pool, sun. 鈫扺ind tank, Taichung. 鈫扴olar rate valley. 鈫扺ind pool. 鈫扴un. 鈫扲ate valley. 鈫扺ind tank. 鈫扖onclusion 1. Available evidence suggests that acupuncture is more effective in preventive treatment of migraine than in blank control. The worst curative effect is comparable with western medicine and the safety is higher. It is not enough to prove that there is a difference between acupuncture and pseudoacupuncture. 2. The most commonly used acupoints for preventive treatment of migraine are Fengchi, rate Valley, Sun, and Sanyin. Combined use of Taichung.
【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】：R246.6

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