耳穴疗法治疗卒中后失眠的随机对照试验Meta分析
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摘要
目的:系统评价耳穴疗法治疗卒中后失眠的临床疗效。方法:检索中文、英文数据库,纳入耳穴疗法对比单纯西药治疗卒中后失眠的随机对照试验(randomized control trials, RCTs)。采用Cochrane协作网的风险偏倚评估工具对纳入研究进行方法学质量评价,采用Cochrane协作网提供的Rev Man 5.3版软件进行Meta分析。结果:本研究共纳入18篇文献,共计1 443例患者。Meta分析结果显示:与单用西药比较,耳穴疗法(包括单纯耳穴治疗、耳穴疗法联合西药治疗、耳穴疗法联合其他疗法治疗)能提高临床有效率[RR=1.64,95%CI(1.45,1.85),P<0.01]、痊愈率[RR=1.73, 95%CI(1.41, 2.13),P<0.01],改善患者的匹兹堡睡眠质量指数(PQSI)评分[SMD=1.23, 95%CI(0.69,1.76),P<0.01]。结论:耳穴相关疗法治疗卒中后失眠较单纯西药治疗具有更好的临床疗效,适合临床推广使用。
Objective: To systematically evaluate the clinical efficacy of auricular acupuncture therapy in the treatment of post-stroke insomnia. Methods: The Chinese and English databases were searched and the clinical randomized controlled trials(RCTs) of auricular acupuncture therapy compared with western medicine alone in the treatment of post-stroke insomnia were included. The methodological quality of the included researches was evaluated by the risk bias assessment tool provided by Cochrane, and the Meta analysis was carried out by Review Manager 5.3 software provided by Cochrane. Results: A total of 18 RCTs including 1 443 patients were included in the study. The results of Meta-analysis showed that compared with western medicine alone, the auricular acupuncture therapy(including auricular acupuncture therapy alone, auricular acupuncture therapy combined with western medicine and auricular acupuncture therapy combined with other therapies) could enhance the clinical effective rate [RR=1.64,95%CI(1.45,1.85),P<0.01] and the cure rate [RR=1.73, 95%CI(1.41, 2.13),P<0.01], and improve the scores of Pittsburgh sleep quality index(PSQI) [SMD=1.23, 95%CI(0.69, 1.76), P<0.01]. Conclusion: Compared with western medicine, the auricular acupoint related therapy shows better clinical effecacy in the treatment of post-stroke insomnia, which is suitable for clinical promotion.
Objective: To systematically evaluate the clinical efficacy of auricular acupuncture therapy in the treatment of post-stroke insomnia. Methods: The Chinese and English databases were searched and the clinical randomized controlled trials(RCTs) of auricular acupuncture therapy compared with western medicine alone in the treatment of post-stroke insomnia were included. The methodological quality of the included researches was evaluated by the risk bias assessment tool provided by Cochrane, and the Meta analysis was carried out by Review Manager 5.3 software provided by Cochrane. Results: A total of 18 RCTs including 1 443 patients were included in the study. The results of Meta-analysis showed that compared with western medicine alone, the auricular acupuncture therapy(including auricular acupuncture therapy alone, auricular acupuncture therapy combined with western medicine and auricular acupuncture therapy combined with other therapies) could enhance the clinical effective rate [RR=1.64,95%CI(1.45,1.85),P<0.01] and the cure rate [RR=1.73, 95%CI(1.41, 2.13),P<0.01], and improve the scores of Pittsburgh sleep quality index(PSQI) [SMD=1.23, 95%CI(0.69, 1.76), P<0.01]. Conclusion: Compared with western medicine, the auricular acupoint related therapy shows better clinical effecacy in the treatment of post-stroke insomnia, which is suitable for clinical promotion.
引文
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[15] 王鑫.耳穴埋豆联合中药湿敷对中风后失眠的效果观察[J].天津护理,2018,26(3):341- 343.
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[22] 张霞,张新生,谢燕.耳穴压丸结合足底按摩/穴位贴敷治疗卒中后睡眠障碍的临床观察[J].中国中医急症,2015,24(2):298- 300.
[23] 王利洪.耳穴治疗脑卒中后失眠的疗效观察[J].实用心脑肺血管病杂志,2011,19(7):1225- 1226.
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[25] 褚爱华.黄连阿胶汤加减辅以耳穴贴敷治疗卒中后失眠症84例临床观察研究[J].中医临床研究,2012,4(7):70- 71.
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[27] 孙利华.王不留行籽耳穴压豆改善脑血管意外患者睡眠障碍的临床观察[D].杭州:浙江大学,2013.
[28] 蒋菁菁,张新玉.五行音乐联合耳穴压丸治疗脑卒中不寐患者的效果观察[J].当代护士(中旬刊),2017(10):87- 88.
[29] 邵子杰.中医辨证施治结合耳穴压豆治疗中风后失眠临床疗效观察[J].亚太传统医药,2014,10(12):85- 86.
[30] 陈晓娜,黄小丽,廖莹莹,等.耳穴埋豆配合五音疗法治疗中风后失眠33例疗效观察[J].云南中医中药杂志,2014,35(1):55- 56.
[31] 刘娜,张子丽.耳穴揿针联合西药治疗脑卒中后失眠临床观察[J].浙江中医药大学学报,2017,41(11):907- 910.
[32] 邢晓彤,张智龙.张智龙运用养血柔肝针法治疗卒中后睡眠障碍经验[J].湖南中医杂志,2018,34(7):30- 32.
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[34] 王巧利,王文春,姜涛,等.针灸联合康复疗法治疗脑血管意外后偏瘫疗效观察[J].辽宁中医杂志,2018,45(9):1941- 1944.
[35] 刘沛沛.针灸与康复治疗脑梗死后偏瘫分析[J].中医临床研究,2018,10(14):62- 64.
[36] 陈鹏典,杨卓欣,于海波,等.督脉电针联合人脐血MSCs移植对脑缺血大鼠VEGF蛋白表达的影响[J].中华中医药学刊,2014,32(6):1261- 1263.
[37] 皮敏,陈鹏典,杨卓欣,等.电针督脉联合人脐血间充质干细胞移植对脑缺血大鼠神经功能缺损及细胞凋亡的影响[J].时珍国医国药,2014,25(2):492- 495.
[38] WOO H L,JI H R,PAK Y K,et al.The efficacy and safety of acupuncture in women with primary dysmenorrhea:A systematic review and meta- analysis[J].Medicine,2018,97(23):e11007.
[39] SALLACH K,LEONHARDT M.Acupuncture for treatment of depressive disorders in pain diseases[J].Der Nervenarzt,2018,89(9):986- 993.
[2] 韦颖辉.脑卒中后睡眠障碍的病因及危险因素分析[J].世界睡眠医学杂志,2018,5(2):149- 151.
[3] ZHANG W,LI F,ZHANG T.Relationship of nocturnal concentrations of melatonin,gamma- aminobutyric acid and total antioxidants in peripheral blood with insomnia after stroke:study protocol for a prospective non- randomized controlled trial[J].Neural Regen Res,2017,12(8):1299- 1307.
[4] CAO Y,YIN X,SOTO- AGUILAR F,et al.Effect of acupuncture on insomnia following stroke:study protocol for a randomized controlled trial[J].Trials,2016,17(1):546.
[5] 周红.脑卒中后睡眠障碍的相关因素分析[J].中国实用神经疾病杂志,2008,11(10):82- 83.
[6] ALLEN N M,LIN J P,LYNCH T,et al.Status dystonicus:a practice guide[J].Dev Med Child Neurol,2014,56(2):105- 112.
[7] LEPP?VUORI A,POHJASVAARA T,VATAJA R,et al.Insomnia in ischemic stroke patients[J].Cerebrovasc Dis,2002,14(2):90- 97.
[8] 牛雁.中西医结合治疗脑卒中后失眠临床观察[J].光明中医,2018,33(18):2744- 2745.
[9] 吴小丽.神阙雷火灸对脑卒中后失眠患者睡眠功能的影响[D].福州:福建中医药大学,2017.
[10] 刘露阳,王鹏琴.眼针治疗卒中后失眠的随机对照研究[J].针刺研究,2017,42(1):67- 71.
[11] 吴小丽,陈捷.针灸治疗脑卒中后失眠研究进展[J].亚太传统医药,2017,13(9):63- 65.
[12] 季向东,王群松,朱文娴.针刺治疗失眠临床疗效及对5- HT含量的影响[J].上海针灸杂志,2015,34(10):961- 963.
[13] 周艳丽.针刺不同腧穴对失眠模型大鼠脑内神经递质5- HT、DA影响的实验研究[J].中国中医基础医学杂志,2012,18(8):887- 888.
[14] 吴国英,方凌云.耳穴埋豆改善中风患者失眠的效果分析[J].现代医药卫生,2012,28(22):3485- 3486.
[15] 王鑫.耳穴埋豆联合中药湿敷对中风后失眠的效果观察[J].天津护理,2018,26(3):341- 343.
[16] 刘素芳,张远玲,李霞,等.耳穴埋豆配合放松训练对中风后失眠的护理疗效观察[J].安徽医药,2017,21(11):2132- 2135.
[17] 梁秀莉.耳穴贴压疗法对卒中后睡眠障碍患者睡眠质量和神经功能缺损的影响[J].河北中医药学报,2016,31(2):37- 39.
[18] 章亚娣,周小娟.耳穴贴压治疗脑卒中恢复期患者失眠疗效分析[J].浙江中西医结合杂志,2016,26(2):133- 135.
[19] 邢雨胜.耳穴贴压治疗中风后失眠32例[J].保健医学研究与实践,2014,11(2):41- 43.
[20] 丁红梅.耳穴压豆配合隔姜灸心俞穴治护脑卒中后睡眠障碍临床观察[J].中医药临床杂志,2014,26(3):227- 229.
[21] 梁冰莲,谭锦秀.耳穴压豆配合贴敷涌泉穴治疗脑卒中病人失眠的效果观察[J].循证护理,2015,1(2):86- 88.
[22] 张霞,张新生,谢燕.耳穴压丸结合足底按摩/穴位贴敷治疗卒中后睡眠障碍的临床观察[J].中国中医急症,2015,24(2):298- 300.
[23] 王利洪.耳穴治疗脑卒中后失眠的疗效观察[J].实用心脑肺血管病杂志,2011,19(7):1225- 1226.
[24] 吴雪兰,陈琴,刘从秀.耳针辨证治疗脑卒中后失眠40例[J].安徽中医学院学报,2012,31(5):45- 46.
[25] 褚爱华.黄连阿胶汤加减辅以耳穴贴敷治疗卒中后失眠症84例临床观察研究[J].中医临床研究,2012,4(7):70- 71.
[26] 李杰萍,姜翠红,吕丽萍.经颅磁疗联合耳穴压豆对脑卒中患者睡眠质量的影响[J].中外医学研究,2016,14(8):93- 94.
[27] 孙利华.王不留行籽耳穴压豆改善脑血管意外患者睡眠障碍的临床观察[D].杭州:浙江大学,2013.
[28] 蒋菁菁,张新玉.五行音乐联合耳穴压丸治疗脑卒中不寐患者的效果观察[J].当代护士(中旬刊),2017(10):87- 88.
[29] 邵子杰.中医辨证施治结合耳穴压豆治疗中风后失眠临床疗效观察[J].亚太传统医药,2014,10(12):85- 86.
[30] 陈晓娜,黄小丽,廖莹莹,等.耳穴埋豆配合五音疗法治疗中风后失眠33例疗效观察[J].云南中医中药杂志,2014,35(1):55- 56.
[31] 刘娜,张子丽.耳穴揿针联合西药治疗脑卒中后失眠临床观察[J].浙江中医药大学学报,2017,41(11):907- 910.
[32] 邢晓彤,张智龙.张智龙运用养血柔肝针法治疗卒中后睡眠障碍经验[J].湖南中医杂志,2018,34(7):30- 32.
[33] 陈洪沛.失眠[M].北京:中国医药科技出版社,2012:43.
[34] 王巧利,王文春,姜涛,等.针灸联合康复疗法治疗脑血管意外后偏瘫疗效观察[J].辽宁中医杂志,2018,45(9):1941- 1944.
[35] 刘沛沛.针灸与康复治疗脑梗死后偏瘫分析[J].中医临床研究,2018,10(14):62- 64.
[36] 陈鹏典,杨卓欣,于海波,等.督脉电针联合人脐血MSCs移植对脑缺血大鼠VEGF蛋白表达的影响[J].中华中医药学刊,2014,32(6):1261- 1263.
[37] 皮敏,陈鹏典,杨卓欣,等.电针督脉联合人脐血间充质干细胞移植对脑缺血大鼠神经功能缺损及细胞凋亡的影响[J].时珍国医国药,2014,25(2):492- 495.
[38] WOO H L,JI H R,PAK Y K,et al.The efficacy and safety of acupuncture in women with primary dysmenorrhea:A systematic review and meta- analysis[J].Medicine,2018,97(23):e11007.
[39] SALLACH K,LEONHARDT M.Acupuncture for treatment of depressive disorders in pain diseases[J].Der Nervenarzt,2018,89(9):986- 993.
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