针刺治疗脑卒中后尿潴留系统评价
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摘要
目的系统评价针刺干预方法对脑卒中后尿潴留临床疗效及安全性。方法计算机检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(CBM)、中国临床试验注册中心(ChiCTR)、Cochrane library、PubMed、Embase建库至2017年11月27日收录的针刺治疗脑卒中后尿潴留随机对照试验文献。2名研究者按照纳入标准独立进行文献筛选及资料提取。采用Cochrane协作网偏倚风险评估工具评估方法学质量,采用Revman5.3软件进行Meta分析,合并效应量后对结果进行GRADE证据质量评价。结果纳入9项研究,涉及649例受试者。Meta分析结果表明,与单纯基础治疗比较,联合针刺能降低58.20m L残余尿量(95%CI[-82.46,-33.94])、提高治愈率(1.61倍,95%CI[1.20,2.18]),针刺治疗的治愈率为药物治疗的1.71倍(95%CI[1.19,2.46]),结局指标均为中等证据质量。针刺不良事件发生率为2.4%,均为一般不良反应。结论针刺能有效降低脑卒中后尿潴留膀胱残余尿量,提高基础治疗治愈率;而有效率及安全性方面,由于纳入样本量少、研究质量偏低,尚需更多高质量临床研究验证。
Objective To systematically assess the efficacy and safety of acupuncture for treatment of urinary retention after cerebral apoplexy. Methods Randomized controlled trials(RCTs) of acupuncture for the treatment of urinary retention after cerebral apoplexy in CNKI, Wanfang Data, CBM, Chi CTR, Cochrane library, Pub Med, and Embase from the establishment to 27~(th) November of 2017 were retrieved by computers. Two investigators independently performed literature screening and data extraction according to inclusion criteria. Methodological quality was assessed using the Cochrane Collaboration Risk Bias Evaluation Tool. Meta-analysis was performed using Revman 5.3 software,and the quality of evidence was evaluated using GRADE after combining the effect sizes. Results There were totally 9 RCTs included, involving 649 patients. Meta-analysis results showed that acupuncture combined with basic treatment could reduce 58.20 mL residual urine volume(95%CI[-82.46,-33.94]) with higher cure rate(1.61 times, 95%CI[1.20,2.18]) compared with single basic treatment. The cure rate of acupuncture treatment was 1.71 times as high as that of medicine treatment(95% CI[1.19, 2.46]). The outcome indicators were of moderate quality of evidence. The incidence of adverse events of acupuncture was 2.4%, all of which were general adverse reactions. Conclusion Acupuncture treatment for urinary retention after cerebral apoplexy can effectively reduce the bladder post-void residual volume,improve the cure rate of basic treatment; Because of the small sample size and the low overall quality of the study,more high-quality clinical studies are needed to verify the efficiency and safety of acupuncture treatment.
Objective To systematically assess the efficacy and safety of acupuncture for treatment of urinary retention after cerebral apoplexy. Methods Randomized controlled trials(RCTs) of acupuncture for the treatment of urinary retention after cerebral apoplexy in CNKI, Wanfang Data, CBM, Chi CTR, Cochrane library, Pub Med, and Embase from the establishment to 27~(th) November of 2017 were retrieved by computers. Two investigators independently performed literature screening and data extraction according to inclusion criteria. Methodological quality was assessed using the Cochrane Collaboration Risk Bias Evaluation Tool. Meta-analysis was performed using Revman 5.3 software,and the quality of evidence was evaluated using GRADE after combining the effect sizes. Results There were totally 9 RCTs included, involving 649 patients. Meta-analysis results showed that acupuncture combined with basic treatment could reduce 58.20 mL residual urine volume(95%CI[-82.46,-33.94]) with higher cure rate(1.61 times, 95%CI[1.20,2.18]) compared with single basic treatment. The cure rate of acupuncture treatment was 1.71 times as high as that of medicine treatment(95% CI[1.19, 2.46]). The outcome indicators were of moderate quality of evidence. The incidence of adverse events of acupuncture was 2.4%, all of which were general adverse reactions. Conclusion Acupuncture treatment for urinary retention after cerebral apoplexy can effectively reduce the bladder post-void residual volume,improve the cure rate of basic treatment; Because of the small sample size and the low overall quality of the study,more high-quality clinical studies are needed to verify the efficiency and safety of acupuncture treatment.
引文
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[12]陶盟,万钢.头皮针加体针治疗中风后尿潴留60例的临床研究[J].中国医药导刊,2016,18(3):251-252.
[13]张淼.“俞募配穴法”针刺治疗中风后尿潴留的临床研究[D].石家庄:河北医科大学,2016.
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[15]杨玉霞,项蓉,刘艳艳,等.十二井穴接经针刺配合膀胱功能训练治疗中风后尿潴留临床研究[J].中国针灸,2017,37(10):1041-1044.
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[18]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[19]周殿元,周正端.现代临床疾病诊断学[M].北京:人民军医出版社,1997:597-598.
[20]陈忠.神经源性膀胱[M].北京:人民卫生出版社,2009:254-256.
[21]吴在德,吴肇汉.外科学[M].北京:人民卫生出版社,2008:677-678.
[22]殷家鸿,周宗惠,陈劲.多个小样本的平均数、标准差、及格率的合并算法[J].昭通学院学报,2010,32(5):61-64.
[23]PANICKER J N,FOWLER C J,KESSLER T M.Lower urinary tract dysfunction in the neurological patient:clinical assessment and management[J].Lancet Neurol,2015,14(7):720-732.
[24]KIM B R,LIM J H,LEE S A,et al.The relation between postvoid residual and occurrence of urinary tract infection after stroke in rehabilitation unit[J].Ann Rehabil Med,2012,36(2):248-253.
[25]廖利民,吴娟,鞠彦合,等.脊髓损伤患者泌尿系管理与临床康复指南[J].中国康复理论与实践,2013,19(4):301-317.
[2]UMEMURA T,OHTA H,YOKOTA A,et al.Urinary retention associated with stroke[J].J UOEH,2016,38(4):263-269.
[3]MENG N H,LO S F,CHOU L W,et al.Incomplete bladder emptying in patients with stroke:is detrusor external sphincter dyssynergia a potential cause?[J].Arch Phys Med Rehabil,2010,91(7):1105-1109.
[4]王一兵.针刺治疗对重症监护患者拔除留置尿管后尿潴留的临床观察[J].内蒙古中医药,2017,36(Z2):133-134.
[5]HIGGINS J,JULIAN P T,GREEN S.Cochrane Handbook for systematic reviews of interventions version 5.1.0[M/OL].(2011-03)[2017-12].The Cochrane Collaboration.http://handbook.cochrane.org/.
[6]GUYATT G H,OXMAN A D,VIST G E,et al.GRADE:an emerging consensus on rating quality of evidence and strength of recommendations[J].BMJ,2008,336(7650):924-926.
[7]刘路然.电针治疗急性脑卒中后排尿障碍的临床研究[J].中医药信息,2008,25(4):71-73.
[8]王忠华,杨波.电针配合膀胱功能训练治疗脑卒中后尿潴留的疗效观察[J].现代泌尿外科杂志,2009,14(2):121-122.
[9]曾超,周尔园.电针结合膀胱训练治疗卒中后神经源性膀胱的临床疗效[J].山东中医药大学学报,2012,36(6):513-515.
[10]龚伟.头针结合盆底肌群锻炼治疗脑卒中后尿潴留的临床疗效观察[D].杭州:浙江中医药大学,2016.
[11]桑鹏,李奕霖,杨辉.头穴透刺治疗脑梗死后尿潴留疗效分析[J].世界复合医学,2016,2(4):54-56.
[12]陶盟,万钢.头皮针加体针治疗中风后尿潴留60例的临床研究[J].中国医药导刊,2016,18(3):251-252.
[13]张淼.“俞募配穴法”针刺治疗中风后尿潴留的临床研究[D].石家庄:河北医科大学,2016.
[14]宋宏杨,高淑红.综合疗法治疗中风后尿潴留22例临床观察[J].湖南中医杂志,2017,33(7):92-94.
[15]杨玉霞,项蓉,刘艳艳,等.十二井穴接经针刺配合膀胱功能训练治疗中风后尿潴留临床研究[J].中国针灸,2017,37(10):1041-1044.
[16]中华医学会全国第四届脑血管病学术会议.各类脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379.
[17]国家中医药管理局脑病急诊科协作组.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.
[18]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[19]周殿元,周正端.现代临床疾病诊断学[M].北京:人民军医出版社,1997:597-598.
[20]陈忠.神经源性膀胱[M].北京:人民卫生出版社,2009:254-256.
[21]吴在德,吴肇汉.外科学[M].北京:人民卫生出版社,2008:677-678.
[22]殷家鸿,周宗惠,陈劲.多个小样本的平均数、标准差、及格率的合并算法[J].昭通学院学报,2010,32(5):61-64.
[23]PANICKER J N,FOWLER C J,KESSLER T M.Lower urinary tract dysfunction in the neurological patient:clinical assessment and management[J].Lancet Neurol,2015,14(7):720-732.
[24]KIM B R,LIM J H,LEE S A,et al.The relation between postvoid residual and occurrence of urinary tract infection after stroke in rehabilitation unit[J].Ann Rehabil Med,2012,36(2):248-253.
[25]廖利民,吴娟,鞠彦合,等.脊髓损伤患者泌尿系管理与临床康复指南[J].中国康复理论与实践,2013,19(4):301-317.