针灸治疗脑出血急性期的Meta分析
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摘要
目的:系统评价针灸治疗脑出血急性期的临床疗效,以期为临床提供循证医学依据。方法:从多个数据库中检索针灸治疗脑出血急性期的随机对照文献,由两名研究者根据纳入和排除标准,独立筛选适合的文献,提取资料并对纳入的研究进行偏倚风险评估。采用统计软件Review Manager 5.3进行Meta分析。结果:共纳入14篇文献,累计病例985例。Meta分析结果显示,7篇文献的总有效率OR=2.97,95%CI为[1.86,4.74],合并效应量检验Z=4.56,P<0.000 01;8篇文献的神经功能缺损积分比较MD值为-2.27,95%CI为[-2.83,-1.71],合并效应量检验Z=7.96,P<0.000 01。治疗组和对照组疗效比较差异有统计学意义(P<0.01)。漏斗图显示发表偏倚可能性较小。结论:针灸治疗脑出血急性期疗效肯定,但鉴于可供纳入研究文献较少,质量较低,尚需更多高质量的研究加以验证。
Objective: To evaluate the clinical efficacy of acupuncture and moxibustion in the treatment of acute cerebral hemorrhage in order to provide evidence-based medicine for clinic.Methods: A randomized controlled literature on the acute phase of cerebral hemorrhage was obtained from multiple databases.Two researchers selected the appropriate literature independently according to the inclusion and exclusion criteria,and extracted the information and evaluated the bias risk.Meta-analysis was performed by using the statistical software Review Manager 5.3.Results: A total of 14 articles were included and 985 cases were accumulated.Meta-analysis showed that the total effective rate of the seven literatures was OR = 2.97,95% CI [1.86,4.74],the combined effect test Z = 4.56,P < 0.000 01; 8 points of neurological deficit score MD =-2.27,95% CI [-2.83,-1.71],the combined effect test Z = 7.96,P < 0.000 01.The difference between the treatment group and the control group was statistically significant(P < 0.01).The funnel graph shows that the publication bias is less likely.Conclusion: Acupuncture and moxibustion treatment of acute cerebral hemorrhage was positive,but in view of the need for inclusion in the literature,the quality is low and still need more high-quality research to be verified.
Objective: To evaluate the clinical efficacy of acupuncture and moxibustion in the treatment of acute cerebral hemorrhage in order to provide evidence-based medicine for clinic.Methods: A randomized controlled literature on the acute phase of cerebral hemorrhage was obtained from multiple databases.Two researchers selected the appropriate literature independently according to the inclusion and exclusion criteria,and extracted the information and evaluated the bias risk.Meta-analysis was performed by using the statistical software Review Manager 5.3.Results: A total of 14 articles were included and 985 cases were accumulated.Meta-analysis showed that the total effective rate of the seven literatures was OR = 2.97,95% CI [1.86,4.74],the combined effect test Z = 4.56,P < 0.000 01; 8 points of neurological deficit score MD =-2.27,95% CI [-2.83,-1.71],the combined effect test Z = 7.96,P < 0.000 01.The difference between the treatment group and the control group was statistically significant(P < 0.01).The funnel graph shows that the publication bias is less likely.Conclusion: Acupuncture and moxibustion treatment of acute cerebral hemorrhage was positive,but in view of the need for inclusion in the literature,the quality is low and still need more high-quality research to be verified.
引文
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[11]刘旭,杨衍宁,刘忠伦,等.早期针灸干预对急性高血压脑出血患者脑水肿消退的临床观察[J].湖南中医药大学学报,2012(8):16-17.
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[14]孔祥顺,于爱萍.早期针灸干预对急性高血压脑出血患者脑水肿消退的临床观察[J].中医临床研究,2015(21):43-44.
[15]仇新臣.浅析针刺联合醒脑静注射液治疗脑出血急性期的临床疗效[J].世界最新医学信息文摘,2016(93):32-33.
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[17]吴君华,舒金堂.醒脑开窍针法治疗急性脑出血的临床观察[J].湖北中医杂志,2016(4):59-60.
[18]杨思进,王蔚,杜渊,等.中医分阶段治疗脑出血急性期临床观察[J].四川中医,2017(3):109-111.
[19]王凌云,李琰,孙亚中.中医针灸配合康复理疗治疗脑出血患者临床疗效及安全性研究[J].亚太传统医药,2017(10):103-104.
[20]马祥玉.针灸联合康复理疗治疗脑出血临床疗效分析[J].数理医药学杂志,2017(4):607-608.
[21]梁楠,武娇娜,刘宪彤.早期针灸康复在高血压脑出血微创术后中的应用分析[J].当代医学,2017(10):38-40.
[22]鲍淑红,谭琪,李晓阳.高压氧联合中医针灸对高血压脑出血患者治疗与护理[J].辽宁中医药大学学报,2017(6):198-201.
[23]马娜,林琳.中西医结合医护措施对急诊高血压脑出血患者血肿吸收及神经功能恢复影响[J].辽宁中医药大学学报,2017(6):210-212.
[24]戴高中,陈跃来,顾法隆.电针对脑出血模型大鼠脑组织一氧化氮、内皮素、总抗氧化能力的影响[J].中国针灸,2002(7):56-58.
[25]陈秋欣,邹伟,牛明明,等.针刺对脑出血大鼠血清TNF-α、IL-6含量的影响[J].上海针灸杂志,2015(10):1006-1008.
[26]于晓刚,东贵荣,周景华.针刺对急性脑出血大鼠TNF-α的影响[J].中国针灸,2004(6):35-39.
[2]胡荣东.超早期康复意识的建立对脑卒中患者肢体功能的影响[J].中国老年学杂志,2004(2):118-119.
[3]Higgins Jpt A D.Chapter 8.Assessing risk of bias in included studies.In:Higgins JPT,Green S(editors)[M].Cochrane Handbook for systematic Reviews of Interventions,2011.
[4]吴琦.针刺配合西医疗法治疗急性脑出血22例临床观察[J].中医杂志,2001(5):279.
[5]李妍.针刺结合西药治疗脑出血急性期临床研究[J].北京中医,2005(2):107-108.
[6]曾庆利.头穴透刺结合清开灵治疗急性脑出血及对脑血管功能调节影响的研究[D].武汉:湖北中医学院,2005.
[7]温秀新.针灸配合西医疗法治疗急性脑出血24例临床探讨[J].医学理论与实践,2006(2):164-165.
[8]吴有兰,夏淑文.针刺结合西药治疗脑出血急性期临床研究[J].山西医药杂志(下半月刊),2009(3):260-261.
[9]邹伟,李丹,于学平,等.针刺治疗急性期高血压脑出血的临床研究[J].中医药信息,2009(5):104-105.
[10]李耀华.针刺法治疗急性脑出血120例[J].辽宁中医杂志,2011(9):1883-1884.
[11]刘旭,杨衍宁,刘忠伦,等.早期针灸干预对急性高血压脑出血患者脑水肿消退的临床观察[J].湖南中医药大学学报,2012(8):16-17.
[12]Yuan P,Bao C L,Dong G R.Clinical safety research of penetrating acupuncture at the head points for cerebral hemorrhage at the acute stage[J].Zhongguo Zhen Jiu,2012,32(7):577-581.
[13]李治忠.醒脑静注射液联合针刺治疗88例脑出血急性期的临床研究[J].中医临床研究,2014(13):40-41.
[14]孔祥顺,于爱萍.早期针灸干预对急性高血压脑出血患者脑水肿消退的临床观察[J].中医临床研究,2015(21):43-44.
[15]仇新臣.浅析针刺联合醒脑静注射液治疗脑出血急性期的临床疗效[J].世界最新医学信息文摘,2016(93):32-33.
[16]郭强,刘荣辉.眼针-头针-电针联合西药治疗急性期基底节区脑出血随机平行对照研究[J].实用中医内科杂志,2016(8):94-97.
[17]吴君华,舒金堂.醒脑开窍针法治疗急性脑出血的临床观察[J].湖北中医杂志,2016(4):59-60.
[18]杨思进,王蔚,杜渊,等.中医分阶段治疗脑出血急性期临床观察[J].四川中医,2017(3):109-111.
[19]王凌云,李琰,孙亚中.中医针灸配合康复理疗治疗脑出血患者临床疗效及安全性研究[J].亚太传统医药,2017(10):103-104.
[20]马祥玉.针灸联合康复理疗治疗脑出血临床疗效分析[J].数理医药学杂志,2017(4):607-608.
[21]梁楠,武娇娜,刘宪彤.早期针灸康复在高血压脑出血微创术后中的应用分析[J].当代医学,2017(10):38-40.
[22]鲍淑红,谭琪,李晓阳.高压氧联合中医针灸对高血压脑出血患者治疗与护理[J].辽宁中医药大学学报,2017(6):198-201.
[23]马娜,林琳.中西医结合医护措施对急诊高血压脑出血患者血肿吸收及神经功能恢复影响[J].辽宁中医药大学学报,2017(6):210-212.
[24]戴高中,陈跃来,顾法隆.电针对脑出血模型大鼠脑组织一氧化氮、内皮素、总抗氧化能力的影响[J].中国针灸,2002(7):56-58.
[25]陈秋欣,邹伟,牛明明,等.针刺对脑出血大鼠血清TNF-α、IL-6含量的影响[J].上海针灸杂志,2015(10):1006-1008.
[26]于晓刚,东贵荣,周景华.针刺对急性脑出血大鼠TNF-α的影响[J].中国针灸,2004(6):35-39.