摘要
目的:基于临床证据,运用多指标决策分析法筛选出针灸治疗股外侧皮神经炎的最优方案,为临床决策提供科学依据。方法:通过计算机检索中国期刊全文数据库、中国生物医学文献数据库、万方数据库、维普全文期刊数据库、PubMed、Cochrane Library及Embase,全面收集各数据库自建库起至2017年12月31日发表的针灸治疗股外侧皮神经炎的随机对照试验(RCT)。用改良的Jadad量表对证据质量进行评价。确定评价指标,用极差变换法对评价指标的量纲进行标准化处理。运用相对比较法确定每个指标的权重并对标准化矩阵进行加权处理。得出理想解和负理想解,计算各方案与理想解的相对贴近度,筛选出针灸治疗股外侧皮神经炎的最优方案。结果:共纳入18项RCT,筛选出的针灸治疗股外侧皮神经炎的最优方案为以细火针迅速点刺皮肤感觉异常区域,速进疾出,重复操作,多点密集成片散刺,每5天治疗1次。结论:基于现有临床证据,细火针点刺感觉异常区域为针灸治疗股外侧皮神经炎的最优方案。梅花针叩刺、浅刺多针法等符合股外侧皮神经炎的疾病特点,适宜临床选用。主穴选取病变局部皮肤感觉异常区域的阿是穴或足阳明和足少阳经穴,并联合腰夹脊穴。
Objective To select the optimized treatment plan of acupuncture for lateral femoral cutaneous neuritis by using multiple indexes decision-making method based on the clinical evidence. Methods The randomized control trials(RCTs) regarding acupuncture for lateral femoral cutaneous neuritis in the CNKI database, CBM database, WANFANG database, VIP database, PubMed, Cochrane Library and Embase published before December 31, 2017 were comprehensively collected. The modified Jadad scale was used to evaluate the quality of the RCTs. Then the evaluation indexes were selected and the dimensions of evaluation indexes were standardized by using extreme difference transformation method. The weight of each index was determined by using relative comparison method and the standardized matrix was weighted. Thus, the ideal solution and the negative ideal solution were obtained, and the relatively degree of each treatment plan to the ideal solution was calculated to propose the optimized plan of acupuncture for lateral femoral cutaneous neuritis. Results A total of 18 RCTs were included, the optimized plan of acupuncture for lateral femoral cutaneous neuritis was using thin fire needle to rapidly prick the abnormal skin region with fast needle insertion-withdrawal technique; the fire needle was applied repeatedly; intensive pricking to form a treatment area; the treatment was given once every 5 days. Conclusion Based on the current clinical evidence, the optimized plan of acupuncture for lateral femoral cutaneous neuritis is using thin fire needle to prick the abnormal skin region; the multiple methods of plum-blossom needling met the characteristic of lateral femoral cutaneous neuritis and is suitable for clinical selection. The main acupoints are ashi points in the abnormal skin area or the acupoints in the foot-yangming meridian and foot-shaoyang meridian, combined with lumbar Jiaji(EX-B2) points.
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