得气对原发性痛经患者经穴效应影响的随机对照试验系统综述

发布时间：2018-03-05 15:53

  本文选题：得气　切入点：经穴效应　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:经穴是针灸的主要刺激部位,经穴效应是针灸治疗起效的基础。得气,是针刺入腧穴后患者和医者感受到的一种特殊针刺感应。从古至今,得气一直被认为是针刺治疗过程中的关键步骤,和针刺疗效密切相关。在针刺的诸多适应症中,针刺镇痛是研究最多、了解最深的领域,研究发现得气与针刺镇痛效应密不可分,所以可将疼痛类疾病作为研究得气与针刺疗效关系的一个突破口,有针对性的进行集中深入研究。疼痛类疾病原发性痛经是年轻女性的常见病、多发病,病源丰富,并且针刺治疗效果显著,因此是研究得气与针刺疗效关系的适宜疾病载体。目的:以疼痛类疾病原发性痛经(PD)为研究载体,系统评价得气对原发性痛经患者经穴效应的影响。方法:检索10个文献数据库(中国知网,维普,万方,中国生物医学文献数据库,Cochrane Library CENTRAL,MEDLINE,Embase,AMED,CINAHL Plus,PsycINFO)、5 个临床试验注册库、论文后参考文献和灰色文献网站OpenGrey。时间从建库至2017年5月1日,没有语种和发表状态限制。收集单纯针刺经穴得气对比不得气或不同得气要素(得气强度、出现时间、持续时间、传导与放射和得气感成分)治疗PD的随机对照试验(RCTs)和半随机对照试验(q-RCTs)。研究质量按照Cochrane偏倚风险评估工具5.1.0评价。若研究间临床异质性小且12≤75%,采用RevMan5.3.5进行定量综合,否则进行定性综合。结果:纳入6项RCTs,共645例患者。因临床异质性大只进行定性综合,结果:①针刺经穴得气或不得气均具有缓解PD疼痛和焦虑的效应;得气时缓解疼痛的效应优于不得气时或与不得气时相当,得气时缓解焦虑的效应与不得气时相比无差异;②得气程度越高、得气穴位数越多,针刺经穴在缓解PD疼痛、症状和减少疼痛时间方面的效应越好;③得气率越高,针刺经穴缓解PD焦虑的效应越好,但缓解疼痛的效应无变化;④得气出现越快并且气至病所,针刺经穴缓解PD疼痛的效应起效越快;⑤有温热得气感或有传导放射至病所的温热得气感,针刺经穴缓解PD疼痛和症状的效应越好。结论:有限的结果表明:针刺经穴得气或不得气均具有治疗效应;得气程度增高、穴位数增多、得气率增高、有温热得气感或有传导放射至病所的温热得气感,可能增强了 PD患者经穴的治疗效应;得气出现快并且气至病所可能加快了 PD患者经穴治疗效应的起效速度。当前结果能在一定程度上验证中医"气至而有效""气速效速"的理论,可为针灸临床运用得气理论提供初步的循证医学依据,而且足以说明有必要进行更多高质量的深入研究。但由于纳入研究的数量少,方法学质量、报告质量不高以及潜在的偏倚,还不能明确得气对PD患者经穴效应的影响如何。本研究方案已在PROSPERO平台注册:CRD42016038518。
[Abstract]:Background: the meridian point is the main stimulating part of acupuncture and moxibustion, and the effect of meridian point is the basis of acupuncture treatment. Deqi has been regarded as a key step in the treatment of acupuncture and is closely related to the efficacy of acupuncture. Among the many indications of acupuncture, acupuncture analgesia is the most studied and well understood field. It has been found that qi is closely related to acupuncture analgesia, so pain diseases can be regarded as a breakthrough in the study of the relationship between Qi acquisition and acupuncture effect. Primary dysmenorrhea is a common disease in young women. Therefore, it is a suitable disease carrier to study the relationship between qi and acupuncture effect. Objective: to study the effect of primary dysmenorrhea (PDD) on painful diseases. Methods: ten literature databases (China Zhiwang, Weipu, Wanfang) and Chinese biomedical literature database (Cochrane Library CENTRALLAL MEDLINELE Embase, CINAHL Plusia PsycINFOONTAL) were systematically evaluated for the effect of dysmenorrhea on the acupoint effect in patients with primary dysmenorrhea. Methods: five clinical trial registries were retrieved from 10 literature databases (China Zhiwang, Weipu, Wanfang, China Biomedical Literature Database). From the establishment of the database to May 1st 2017, there are no language and publication state restrictions. Duration, The quality of the study was evaluated according to the Cochrane bias risk assessment tool 5.1.0. If the clinical heterogeneity was small and 12 鈮，

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