摘要
目的评价针刺治疗脑卒中后肌痉挛的疗效和安全性。方法计算机检索国内外6大数据库。纳入针刺与非针刺比较的随机对照试验。两位研究人员独立进行文献筛选、资料提取和纳入研究质量评价,质量评价采用Cochrane协作网的偏倚风险评估工具。使用Rev Man5.3进行数据分析,计量资料计算均值差(MD)及其95%可信区间(CI)。结果共纳入29篇文献。7个研究存在高偏倚风险,其余均具有偏倚风险不清楚的条目。在缓解肢体痉挛程度方面,针刺优于康复训练(-0.40[-0.68,-0.12]),在治疗4周及8周后未明确痉挛部位的研究中,针刺联合康复训练优于单用康复训练(-0.31[-0.50,-0.11]、-0.41[-0.54,-0.28]);治疗4周后,针刺联合常规治疗较优于康复训练联合常规治疗(-0.96[-1.73,-0.19]),针刺联合康复训练与常规治疗优于康复训练与常规治疗(-0.57[-0.80,-0.34]);治疗6个月后,针刺联合神经阻滞治疗与康复训练优于神经阻滞治疗与康复训练(-0.63[-1.12,-0.14]);针刺联合神经阻滞治疗优于神经阻滞治疗(-0.70[-1.08,-0.32])。在改善肢体活动程度方面,针刺单独使用、针刺联合康复训练、针刺联合常规治疗与康复训练治疗后1周及4周、针刺联合神经阻滞治疗疗效优于对照组。结论针刺疗法有助于改善脑卒中后肌痉挛患者的肢体痉挛程度、肢体活动能力及日常生活能力,但各亚组间结论不一致,期望今后开展更多明确痉挛部位、多个测量时点的高质量随机对照试验以进一步验证其疗效。
Objective To evaluate the effectiveness and safety of acupuncture in the management of poststroke spasticity.Methods Six domestic and abroad databases were screened by computer.Randomized controlled trials（RCT） were included if acupuncture treatment was used as the sole intervention or as an adjunction to another conventional treatment on post-stroke spasticity.Two independent reviewers screened the articles,extracted data and assessed the risk of bias.The evaluation of the quality was performed using Cochrane Risk of Bias Tool and the data was analyzed by using Rev Man 5.3.Mean difference（MD） and 95% confidence interval（CI） were used to describe quantitative data.Results A total 29 RCT were included,7 of them had high risk of bias and the rest of them had unclear risk of bias.Acupuncture was better than rehabilitation therapy in remission of spasticity（-0.40 [-0.68,-0.12]）.The 4 or 8 weeks of treatment in studies of unmentioned spasmodic regions showed that acupuncture with rehabilitation therapy was better than rehabilitation therapy（-0.31[-0.50,-0.11],-0.41[-0.54,-0.28]）.The studies of 4 weeks of treatment showed superior effect of acupuncture with conventional treatment compared with rehabilitation therapy with conventional treatment（-0.96[-1.73,-0.19]）,and acupuncture with rehabilitation therapy was superior to conventional treatment with rehabilitation therapy（-0.57[-0.80,-0.34]）.After 6 months of treatment,acupuncture with nerve block therapy and rehabilitation therapy was better than nerve block therapy with rehabilitation therapy（-0.63[-1.12,-0.14]）,and acupuncture with nerve block therapy was better than nerve block therapy（-0.70[-1.08,-0.32]）.In improving the physical activity,acupuncture,acupuncture with rehabilitation therapy,acupuncture with conventional treatment and rehabilitation therapy 1 or 4 weeks of follow-up,and acupuncture with nerve block therapy was better than that of control group.Conclusion Acupuncture could remiss the spasticity after stroke and improve the ability of daily life and motor function of patient,but the conclusion of subgroups are not the same.The high quality RCT studies with clear spasmodic position and measurement at more time points are needed to confirm the effectiveness and safety of acupuncture in post-stroke patients with spasticity.
出处
《北京中医药大学学报》
CAS
CSCD
北大核心
2017年第1期52-58,共7页
Journal of Beijing University of Traditional Chinese Medicine
基金
2013年教育部新世纪优秀人才支持计划项目(No.NCET-13-0694)
2013年北京市科技新星计划项目(No.Z131107000413031)
2016年北京中医药大学在读研究生项目(No.2016-JYB-XS035)
关键词
脑卒中
肌痉挛
痉挛状态
针刺
系统综述
stroke
muscular spasm
spasticity
acupuncture
systematic review
