针刺联合康复疗法治疗中风后吞咽障碍的Meta分析
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摘要
【目的】评价针刺联合康复疗法治疗中风后吞咽障碍的临床疗效及安全性。【方法】检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普期刊数据库(VIP)、万方数据库中近10年来发表于期刊的针灸联合康复疗法对比单纯康复疗法和/或常规西药干预(对照组)治疗中风后吞咽障碍的临床随机对照试验文献,对纳入的文献质量进行评价后,采用RevMan 5.3软件进行Meta分析。【结果】最终纳入文献16篇,总病例数为1 780例。Meta分析结果显示,针刺联合康复疗法治疗中风后吞咽障碍的总有效率优于对照组(RR=1.22,95%CI[1.16,1.28],Z=7.80,P<0. 01);在改善洼田饮水试验评分(MD=-0.66,95%CI[-0.78,-0.53],Z=10.62)及改善吞咽障碍临床评价量表评分(MD=2.01,95%CI[1.78,2.24],Z=17.30)方面均优于对照组(P<0. 01)。【结论】针刺联合康复疗法治疗中风后吞咽障碍具有较好的疗效;但因所纳入分析的文献质量不高,结论有待更高质量的临床试验验证。
Objective To systematically evaluate the effectiveness and safety of acupuncture combined with rehabilitation therapy for the treatment of dysphagia after stroke. Methods Randomized clinical trials(RCTs)of acupuncture combined with rehabilitation therapy versus rehabilitation alone or/and conventional western medicine(control group)for the treatment of dysphagia after stroke issued in the periodicals enrolled in the databases of CBM,CNKI,VIP and Wanfang were analyzed. The literature quality of the qualified RCTs was evaluated,and then RevMan 5.3 software was used for the Meta analysis. Results Sixteen RCTs involving a total of 1 780 cases were included the analysis. The results of Meta-analysis showed that acupuncture combined with rehabilitation therapy had higher total effective rate(RR = 1.22,95%CI[1.16,1.28],Z = 7.80,P<0.01),and had stronger effect on improving the scores of Kubota Water Swallowing Test(MD =-0.66, 95% CI[-0.78,-0.53], Z =10.62) and dysphagia scale(MD = 2.01,95%CI[1.78,2.24],Z = 17.30)than the control group(P<0.01).Conclusion Acupuncture combined with rehabilitation therapy exerts certain effects for the treatment of dysphagia after stroke;for the quality of the included studies is low,the conclusion still need high-quality RCTs to verify.
Objective To systematically evaluate the effectiveness and safety of acupuncture combined with rehabilitation therapy for the treatment of dysphagia after stroke. Methods Randomized clinical trials(RCTs)of acupuncture combined with rehabilitation therapy versus rehabilitation alone or/and conventional western medicine(control group)for the treatment of dysphagia after stroke issued in the periodicals enrolled in the databases of CBM,CNKI,VIP and Wanfang were analyzed. The literature quality of the qualified RCTs was evaluated,and then RevMan 5.3 software was used for the Meta analysis. Results Sixteen RCTs involving a total of 1 780 cases were included the analysis. The results of Meta-analysis showed that acupuncture combined with rehabilitation therapy had higher total effective rate(RR = 1.22,95%CI[1.16,1.28],Z = 7.80,P<0.01),and had stronger effect on improving the scores of Kubota Water Swallowing Test(MD =-0.66, 95% CI[-0.78,-0.53], Z =10.62) and dysphagia scale(MD = 2.01,95%CI[1.78,2.24],Z = 17.30)than the control group(P<0.01).Conclusion Acupuncture combined with rehabilitation therapy exerts certain effects for the treatment of dysphagia after stroke;for the quality of the included studies is low,the conclusion still need high-quality RCTs to verify.
引文
[1]中华医学会神经病学分会脑血管病学组缺血性卒中二级预防指南撰写组.中国缺血性卒中和短暂性脑缺血发作二级预防指南2010[J].中华神经科杂志,2010,43(3):154.
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[10]刘玲,刘海波,王晓玲,等.重复经颅磁刺激治疗卒中后吞咽功能障碍的系统文献回顾[J].中国脑血管病杂志,2014,11(5):250.
[11]刘兰兰,文国强,欧阳锋,等.醒脑开窍针刺法结合功能训练治疗卒中后吞咽障碍疗效观察[J].中国康复理论与实践,2007,13(10):963.
[12]夏文广,郑婵娟,朱遂强,等.脑卒中后吞咽障碍综合康复治疗的评价[J].华中科技大学学报(医学版),2010,39(5):614.
[13]武平,梁繁荣,于白莉,等.不同时期介入针刺和康复疗法对脑卒中后吞咽障碍疗效的影响[J].中国康复理论与实践,2011,17(8):733.
[14]童吉力,周琦,罗贤良,等.耳三针治疗脑卒中后假性球麻痹40例临床观察[J].吉林中医药,2011,31(9):880.
[15]余志辉,胡建芳.针刺配合康复疗法治疗脑卒中后吞咽困难疗效观察[J].上海针灸杂志,2012,31(9):642.
[16]李飞,汤敬一,程红亮,等.针刺加冷刺激配合舌肌训练对脑卒中吞咽障碍患者的康复疗效评价[J].中华中医药杂志,2012,27(9):2471.
[17]李芬芳.早期康复结合针刺治疗脑卒中吞咽障碍临床疗效观察[J].新中医,2012,44(6):147.
[18]庄淑美,吕海波,刘建桥.针刺结合康复疗法治疗脑卒中后吞咽困难疗效观察[J].中国中医基础医学杂志, 2013,19(7):847.
[19]雷奕祺,李如良,林巧芬,等.曾氏太极针法治疗脑卒中后假性球麻痹65例[J].辽宁中医杂志, 2013,40(4):780.
[20]佟帅,吕海波,刘建桥.针刺结合吞咽功能训练治疗脑卒中后(咽期)吞咽障碍临床疗效观察[J].中医药学报, 2014,42(2):129.
[21]高世毅,何圣三.项三针合吞咽功能训练治疗脑卒中后吞咽障碍30例临床观察[J].湖南中医杂志, 2014,30(5):77.
[22]孙纪伟,张根明,李信军.针灸治疗脑卒中后吞咽障碍161例[J].河南中医,2016,41(3):460.
[23]谯智泉,陈方芳,罗永浩.针灸治疗脑卒中后吞咽功能障碍43例[J].河南中医, 2016,41(8):1356.
[24]陈香妹,林慧娟.醒脑开窍针刺法治疗脑卒中后吞咽障碍59例[J].江西中医药,2016,47(8):71.
[25]杨春光,朱彬,廖明霞,等.电针头针配合吞咽训练治疗脑卒中后假性球麻痹吞咽障碍临床研究[J].四川中医,2016,34(6):195.
[26]陈诗玲,倪光夏.针刺配合吞咽康复疗法治疗中风后假性球麻痹吞咽困难患者40例临床观察[J].中医杂志,2017,58(5):401.
[27]王雪苔.从针灸临床特点探讨针灸研究方法学[J].中国针灸,2003,23(1):1.
[2] Han T R,Paik N J,Park J W. Quantifying swallowing function after stroke:a functional dysphagia scale based on videofluoroscopic studies[J]. Arch Physmed Rchabil,2001,82(5):677.
[3] Katzan I L, Ebul R D, Usak S H, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke[J]. Neurology,2003,60(4):620.
[4]郭泽新,汪润生.治疗中风偏瘫需要针灸与康复医学的结合[J].中国针灸,2002,22(4):20.
[5]国家中医药管理局脑病急症协作组.中风病诊断与疗效评定标准(试行)[J].北京中医药大学学报,1996,19(1):55.
[6]吴逊.全国第四届脑血管病学术会议纪要[J].卒中与神经疾病,1997,4(2):51.
[7]陈伟群,王新德.全国第五届脑血管病学术会议纪要[J].中华神经科杂志,2000,33(4):252.
[8]王忠诚.第二次全国脑血管病专题学术会议纪要[J].中华神经外科杂志,1987,3(2):63.
[9]王丽平,解越.针灸治疗卒中后吞咽困难的系统评价[J].中国针灸,2006,26(2):141.
[10]刘玲,刘海波,王晓玲,等.重复经颅磁刺激治疗卒中后吞咽功能障碍的系统文献回顾[J].中国脑血管病杂志,2014,11(5):250.
[11]刘兰兰,文国强,欧阳锋,等.醒脑开窍针刺法结合功能训练治疗卒中后吞咽障碍疗效观察[J].中国康复理论与实践,2007,13(10):963.
[12]夏文广,郑婵娟,朱遂强,等.脑卒中后吞咽障碍综合康复治疗的评价[J].华中科技大学学报(医学版),2010,39(5):614.
[13]武平,梁繁荣,于白莉,等.不同时期介入针刺和康复疗法对脑卒中后吞咽障碍疗效的影响[J].中国康复理论与实践,2011,17(8):733.
[14]童吉力,周琦,罗贤良,等.耳三针治疗脑卒中后假性球麻痹40例临床观察[J].吉林中医药,2011,31(9):880.
[15]余志辉,胡建芳.针刺配合康复疗法治疗脑卒中后吞咽困难疗效观察[J].上海针灸杂志,2012,31(9):642.
[16]李飞,汤敬一,程红亮,等.针刺加冷刺激配合舌肌训练对脑卒中吞咽障碍患者的康复疗效评价[J].中华中医药杂志,2012,27(9):2471.
[17]李芬芳.早期康复结合针刺治疗脑卒中吞咽障碍临床疗效观察[J].新中医,2012,44(6):147.
[18]庄淑美,吕海波,刘建桥.针刺结合康复疗法治疗脑卒中后吞咽困难疗效观察[J].中国中医基础医学杂志, 2013,19(7):847.
[19]雷奕祺,李如良,林巧芬,等.曾氏太极针法治疗脑卒中后假性球麻痹65例[J].辽宁中医杂志, 2013,40(4):780.
[20]佟帅,吕海波,刘建桥.针刺结合吞咽功能训练治疗脑卒中后(咽期)吞咽障碍临床疗效观察[J].中医药学报, 2014,42(2):129.
[21]高世毅,何圣三.项三针合吞咽功能训练治疗脑卒中后吞咽障碍30例临床观察[J].湖南中医杂志, 2014,30(5):77.
[22]孙纪伟,张根明,李信军.针灸治疗脑卒中后吞咽障碍161例[J].河南中医,2016,41(3):460.
[23]谯智泉,陈方芳,罗永浩.针灸治疗脑卒中后吞咽功能障碍43例[J].河南中医, 2016,41(8):1356.
[24]陈香妹,林慧娟.醒脑开窍针刺法治疗脑卒中后吞咽障碍59例[J].江西中医药,2016,47(8):71.
[25]杨春光,朱彬,廖明霞,等.电针头针配合吞咽训练治疗脑卒中后假性球麻痹吞咽障碍临床研究[J].四川中医,2016,34(6):195.
[26]陈诗玲,倪光夏.针刺配合吞咽康复疗法治疗中风后假性球麻痹吞咽困难患者40例临床观察[J].中医杂志,2017,58(5):401.
[27]王雪苔.从针灸临床特点探讨针灸研究方法学[J].中国针灸,2003,23(1):1.