针刺治疗癌性疼痛随机对照试验的系统评价

发布时间：2018-04-17 22:17

本文选题：针刺 + 癌症　；参考：《黑龙江中医药大学》2016年硕士论文

【摘要】：目的：通过运用循证医学系统评价及Meta分析的研究方法,对针刺治疗癌性疼痛的疗效及安全性进行评价,为临床针刺治疗癌性疼痛的应用提供循证医学证据。分析针刺治疗癌性疼痛的随机对照试验在方法学应用方面存在的不足,为日后针刺治疗癌性疼痛随机对照试验的开展、设计、报告等方面提供参考意见,提高针刺治疗癌性疼痛的随机对照试验及临床研究的质量。方法：拟定科学的文献检索策略,采用计算机检索,电子数据库包括中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普数据库(VIP)、万方数字化期刊群(WAN FANG)、美国国立医学图书馆生物医学信息数据库(Medline via PubMed)和Cochrane图书馆临床对照试验注册资料库(Cochrane Central Register of Controlled Trials)检索日期均从建库到2015年12月31日。搜集有关针刺治疗癌性疼痛的临床随机对照试验研究的文献,按照临床科研设计、衡量、评价和循证医学的原则,资料提取由两名提取者独立进行,通过阅读题目和文章摘要的方法剔除与本研究不相关的文章和重复发表的文章,详细阅读全文再次剔除不符合纳入标准的文献。按照国际循证医学联盟推荐使用的偏倚风险评估工具(Risk of bias tool)对纳入文献的方法学质量进行评价,采用国际循证医学协作网开发的Revman5.3软件进行Meta分析。结果：1.文献质量评价结果：本研究共纳入22篇研究文献,经过文献质量评价及偏倚风险评估,最终B级研究14个,C级研究8个。2. Meta分析结果：(1)单纯针刺与西药比较治疗癌性疼痛的Meta分析共纳入9篇研究文献,Meta分析结果提示,针刺在提高临床总有效率方面与对照组比较差异有统计学意义,OR=1.93,95% CI (1.12,3.32), P0.05,提示针刺疗法治疗癌性疼痛临床疗效优于西药。且该研究材料的偏倚性较小,所得结论稳健、可信。由于疗效观察方法不同,排除以合并累积方法计算镇痛治疗效果的研究1个,对其余8篇研究文献进行Meta分析,统计分析表明,针刺在提高临床总有效率方面与对照组比较差异有统计学意义,OR=2.19,95% CI (1.18,4.09), P0.01,敏感性分析结果显示与总体结果一致。(2)针刺为主配合其他疗法与西药比较治疗癌性疼痛的Meta分析共纳入13篇研究文献,Meta分析结果显示,针刺在提高临床总有效率方面与对照组比较差异有统计学意义,OR=4.78,95%CI(3.16,7.23), P0.01,在不良反应发生率方面与对照组比较差异有统计学意义,OR=0.27,95%CI (0.18,0.41), P0.01,提示针刺为主配合其他疗法治疗癌性疼痛临床疗效优于西药,可以减轻药物产生的不良反应发生。且该研究材料的偏倚性较小,所得结论稳健、可信。结论：1.纳入本研究的文献质量整体偏低,提示文献的质量问题以及存在的偏倚一定程度上影响了研究结果的可信度。2.针刺可以有效缓解癌性疼痛,安全且易于操作,明显降低药物的不良反应发生率,在一定程度上可提高患者的生存质量,但长期疗效并不确定,有待进一步的研究。3.针刺治疗癌性疼痛的随机对照试验在方法学方面存在缺陷,需要进一步改进以提高研究报告的质量。
[Abstract]:Objective: through the use of research methods through the analysis and evaluation of Meta medical system, to evaluate the efficacy and safety of acupuncture in the treatment of cancer pain, provide evidence for the clinical application of acupuncture in the treatment of cancer pain. Randomized controlled analysis of acupuncture in the treatment of cancer pain test problems in methodology application. The treatment of cancer pain, randomized controlled trials on acupuncture development, design, and other aspects of the report for reference, and improve the quality of clinical randomized controlled trials on acupuncture in the treatment of cancer pain. Methods: to establish scientific literature retrieval strategy, using computer retrieval, electronic databases including biomedical literature database (CBM China Chinese), HowNet (CNKI), VIP database (VIP), Wanfang digital periodical group (WAN FANG), biomedical information database of the National Library of Medicine (Medline via PubMed) and C Ochrane controlled trials register (Cochrane Central Register of Controlled Trials) retrieval date from inception to December 31, 2015. Collect information about acupuncture in the treatment of cancer pain clinical randomized controlled trials research literature, as measured by the clinical research design, evaluation, and the principle of evidence-based medicine, extracted by two extraction are independent. By eliminating method of reading the title and abstract of this study was not associated with the repeated articles and published articles, with full text again excluding the literatures met the inclusion criteria. According to the international evidence-based Medicine Association recommends bias risk assessment tools used (Risk of bias tool) on the methodological quality evaluation of Meta analysis using the international evidence-based medicine network developed by Revman5.3 software. Results: 1. literature quality evaluation results: This study The 22 study included literature, through literature quality evaluation and bias of risk assessment, the final B of 14, C of 8.2. Meta analysis results: (1) Meta analysis of acupuncture versus Western medicine in the treatment of cancer pain included a total of 9 research papers, Meta analysis showed that acupuncture was statistically significant to improve the clinical total efficiency differences compared with the control group, OR=1.93,95% CI (1.12,3.32), P0.05, suggesting that acupuncture therapy in the treatment of cancer pain clinical curative effect is better than western medicine. And the study of material bias is small, the conclusion is steady, credible. Because the efficacy of different methods, combined with calculation method of the exclusion of cumulative analgesic effect of treatment 1, Meta analysis was conducted on the remaining 8 research papers, statistical analysis shows that acupuncture has statistical significance in improving the clinical total efficiency compared with the control group differences, OR= 2.19,95% CI (1.18,4.09), P0. 01, the sensitivity analysis results show consistent with the overall results. (2) acupuncture therapy and Western medicine combined with other Meta analysis and comparison of the treatment of cancer pain included a total of 13 research papers, the results of Meta analysis showed that acupuncture has statistical significance in improving the clinical total efficiency differences compared with the control group, OR=4.78,95%CI (3.16,7.23), P0.01 in the adverse reaction, compared with the control group rate was statistically significant (0.18,0.41, OR=0.27,95%CI), P0.01, suggesting that acupuncture combined with other therapy in the treatment of cancer pain clinical curative effect is better than that of Western medicine, can alleviate the adverse drug reactions have occurred. And the study of material bias is small, the conclusion is steady, credible. Conclusion: 1. enrolled in the study of literature is low overall quality, prompt quality problems of the literature and the existing bias to some extent affected the credibility of the research results of.2. acupuncture Can effectively relieve cancer pain, safe and easy operation, significantly reduce the incidence of adverse drug reactions, to a certain extent, can improve the quality of life of patients, but the long-term effect is uncertain, randomized controlled trials of acupuncture treatment of.3. cancer pain further in methodological flaws, needs to be further improved to improve study on the quality of the report.

【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】：2016
【分类号】：R246.5

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