摘要
目的系统评价针刺及电针治疗对中风后吞咽障碍的疗效。方法计算机检索中国生物医学文献服务系统(Sino Med)、中文期刊全文数据库(CNKI)、万方数据库(WANFANG DATA),同时对外文文献进行查阅,主要应用的数据库为Pub Med、Embase、Cochrane Library,对数据库中的针刺治疗、电针治疗中风后的吞咽障碍临床文献进行检索,文献类型为随机对照试验(RCT)。由两位研究者根据纳入排除标准筛选文献、提取资料并利用Cochrane偏倚工具对纳入研究进行方法学质量评价,采用Stata 14.0软件进行Meta分析。结果共纳入文献30篇,其中针刺组27篇,电针组3篇,共涉及病例2446例纳入本研究。Meta分析结果显示,电针治疗组在治疗中风后吞咽障碍患者的总有效率[RR=1.53,95%CI(1.14,2.06),Z=2.81(P=0.005<0.05)]、显效率[RR=2.25,95%CI(1.49,3.40),Z=3.87(P<0.05)]均优于对照组,且差异有统计学意义。针刺组在治疗中风后吞咽障碍患者的总有效率[RR=1.21,95%CI(1.16,1.25),Z=9.98(P<0.05)]、显效率[RR=1.45,95%CI(1.34,1.58),Z=8.94(P<0.05)],洼田饮水分级[WMD=-0.69,95%CI(-0.78,-0.60),Z=15.06(P<0.05)],SSA标准吞咽评估[WMD=-3.41,95%CI(-3.98,-2.84),Z=11.66(P<0.05)]均优于对照组,差异有统计学意义,在降低肺部感染率方面,针刺治疗组和对照组比较,[RR=0.70,95%CI(0.43,1.12),Z=1.48(P=0.139>0.05)],其结果差异无统计学意义。电针总有效率的证据评级为极低级,电针组和针刺组显效率,针刺组的总有效率,洼田饮水分级,SSA标准吞咽功能评估及肺部感染率的证据级别均为低级。结论脑卒中后吞咽障碍患者中采用电针和针刺治疗方法,其临床疗效较好,但因纳入研究的数量及质量有限,该研究需要更多高质量的研究支撑。
Objective To systematically evaluate the efficacy of acupuncture and electro-acupuncture in the treatment of dysphagia after stroke.Methods Randomized controlled trials on acupuncture and electro-acupuncture for dysphagia after stroke were retrieved from Sino Med,CNKI,Wanfang Data,Pub Med,Embase and Cochrane Library since the establishment of the database.Two researchers screened the literature according to the inclusion and exclusion criteria,extracted the data,and evaluated the methodological quality of the included studies using the Cochrane bias tool.Meta-analysis was performed using Stata 14.0 software.Results A total of 30 literatures were included in the study,27 literatures in acupuncture group and 3 literatures in electro-acupuncture group were included in this study,involving a total of 2446 patients.The results of meta-analysis showed that the total effective rate[RR=1.53,95%CI(1.14,2.06),Z=2.81(P=0.005<0.05)]and significant efficiency[RR=2.25,95%CI(1.49,3.40),Z=3.87(P<0.05)]in the electro-acupuncture group compared with the control group were statistically significant.Comparison between acupuncture treatment group and control group:total effective rate[RR=1.21,95%CI(1.16,1.25),Z=9.98(P<0.05)],significant efficiency[RR=1.45,95%CI(1.34,1.58),Z=8.94(P<0.05)],Kubota water swallow grade[WMD=-0.69,95%CI(-0.78,-0.60),Z=15.06(P<0.05)],SSA[WMD=-3.41,95%CI(-3.98,-2.84),Z=11.66(P<0.05)].The pulmonary infection rate[RR=0.70,95%CI(0.43,1.12),Z=1.48(P=0.139>0.05)]was not statistically significant.The level of evidence for the total effective rate of electroacupuncture is extremely low,and the levels of evidence for the electroacupuncture group and the acupuncture group are markedly effective,the total effective rate of the acupuncture group,the drinking water classification of Watian,the SSA standard swallowing function assessment and the evidence level of lung infection rate are all For low-level.Conclusion Electro-acupuncture and acupuncture have a good clinical effect in the treatment of dysphagia after stroke,but due to the limited number and quality of included literatures,this research needs more high-quality research support.
作者
李婷婷
冯路达
孙千惠
解小龙
王博远
李传朋
高颖
LI Ting-ting;FENG Lu-da;SUN Qian-hui;XIE xiao-long;WANG Bo-yuan;LI Chuan-peng;CAO Ying(Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700;Beijing University of Chinese Medi.cine,Beijing 100029)
出处
《世界中西医结合杂志》
2021年第5期804-811,816,共9页
World Journal of Integrated Traditional and Western Medicine
基金
国家重点研发计划(2018YFC1705001)。
