穴位注射治疗三叉神经痛的系统评价

发布时间：2018-07-25 18:50

【摘要】：目的临床穴位注射治疗三叉神经痛的疗效暂无确切证据,本次系统评价拟用循证医学的方法对穴位注射治疗三叉神经痛的疗效进行评估。方法参照Cochrane协作网规定的系统评价原则,制定检索策略,全面检索国内外有关穴位注射治疗三叉神经痛的RCTs。计算机检索清华同方CNKI数据库、PubMed、CBM等数据库。制定纳入标准,并按照诊断标准进行文献筛选。然后提取数据,再按Cochrane协作网的“偏倚风险评估标准”对筛选出的文献进行质量评级。用RevMan5.3软件对数据进行Meta分析,并用GradePro3.6软件对结局证据质量等级进行评价。结果最后纳入10个研究,共715例患者。有7个研究报告了(n=491)穴位注射配合针刺与针刺比较的有效率,合并效应量RR=1.22,95%CI[1.13,1.30].7个研究中,3个研究是用中成药进行穴位注射,RR=1.22,95%CI[1.09,1.36]; 3个研究是维生素+局麻药进行穴位注射,RR=1.19,95%CI[1.08,1.31];1个研究是维生素进行穴位注射,Meta分析RR=1.33,95%CI[1.04,1.72].显示穴位注射配合针刺疗效高于单纯针刺的疗效。2篇研究是穴位注射与口服卡马西平对照,RR=1.12,95%CI[0.94,1.33],合并效应量95%CI跨越无效线,说明两个研究合并结果无统计学意义,敏感性分析结果与Meta分析不一致,该结果可靠性较低,不能说明穴位注射疗效是否优于卡马西平。1篇文章报告了穴位注射联合电针与单纯电针的对照,两组的差别有统计学意义(P0.05)。提示穴位注射联合电针的效果高于单纯使用电针治疗的疗效。但其Meta分析RR的95%CI跨无效线,不能提示穴位注射配合电针的疗效比单纯电针高。GRADE证据质量评价,穴位注射配合针刺VS单纯针刺、穴位注射VS卡马西平、穴位注射联合电针VS电针质量等级均为D级(very low)。10篇研究均未报告穴位注射疗法的不良反应。结论穴位注射治疗三叉神经痛可能具有一定疗效,未报到不良反应。但由于文献质量较低,纳入的文献数量较少,语种仅为中文,使得结论的可靠性受到影响,且GRADE证据质量评级较低,结果需谨慎对待。因此有必要进行高质量的临床RCTs,为穴位注射治疗三叉神经痛的疗效评价提供可信度更高的临床证据。穴位注射治疗TN的药物选择种类不一,不太规范。需要更多相关研究,以规范穴位注射治疗TN的药物选择,提供更优的药物注射方案。
[Abstract]:Objective to evaluate the efficacy of acupoint injection in the treatment of trigeminal neuralgia. Methods according to the systematic evaluation principle stipulated by Cochrane Cooperative Network, the retrieval strategy was formulated, and the RCTs of acupoint injection in treating trigeminal neuralgia at home and abroad were comprehensively searched. To search the database of Tongfang CNKI in Tsinghua University by computer. The inclusion criteria were established and the literature was screened according to the diagnostic criteria. Then the data are extracted and the selected documents are rated according to the bias risk assessment criteria of Cochrane collaboration. RevMan5.3 software was used to analyze the data by Meta, and GradePro3.6 software was used to evaluate the quality of the outcome evidence. Results A total of 715 patients were enrolled in 10 studies. Seven studies have reported the effective rate of point injection combined with acupuncture in comparison with acupuncture. Among the 7 studies, 3 studies were done with Chinese patent medicine for acupoint injection (RRX 1.2295CI [1.09N1.36]; three studies were for vitamin local anesthetics for acupoint injection of RRN 1.1995CI [1.081.31]; one study was for point injection meta analysis of RRN 1.3395CI [1.04m1.72]. The results showed that the therapeutic effect of acupuncture combined with acupoint injection was higher than that of acupuncture alone. The results of the two studies showed that the combination of acupoint injection and oral carbamazepine had no statistical significance. The combined effect amount of 95%CI crossed the invalid line, and there was no significant difference between the two studies. The result of sensitivity analysis was inconsistent with that of Meta analysis, and the reliability of the result was low, which could not explain whether the curative effect of acupoint injection was better than that of carbamazepine. 1. The comparison between acupoint injection combined with electroacupuncture and simple electroacupuncture was reported. The difference between the two groups was statistically significant (P0.05). The results suggest that the effect of acupoint injection combined with electroacupuncture is higher than that of electroacupuncture alone. However, the Meta analysis of the 95%CI line of RR did not suggest that the efficacy of acupoint injection combined with electroacupuncture was higher than that of electroacupuncture alone. The quality of evidence was higher than that of electroacupuncture alone. Point injection combined with acupuncture with vs was simple acupuncture, and acupoint injection of vs carbamazepine was more effective than that of electroacupuncture alone. The quality grade of acupoint injection combined with electroacupuncture vs electroacupuncture was D grade (very low). 10 studies did not report the adverse reactions of acupoint injection therapy. Conclusion Acupoint injection may be effective in the treatment of trigeminal neuralgia. However, the reliability of the conclusions is affected because of the low quality of the literature, the small number of documents included and the Chinese language, and the low quality rating of GRADE evidence, so the results need to be treated with caution. Therefore, it is necessary to carry out high quality clinical RCTs to provide more reliable clinical evidence for the evaluation of the efficacy of acupoint injection in the treatment of trigeminal neuralgia. The drug choice of point injection for TN is different and not very standard. More research is needed to standardize the drug selection of point injection therapy for TN and to provide a better drug injection protocol.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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