摘要
目的 采用网状meta分析方法评价不同针灸疗法对中风后运动功能障碍患者的效果.方法 计算机检索PubMed、Embase、Cochrane、CNKI、万方数据知识服务平台、维普网建库至 2022 年 10 月针灸治疗中风后运动功能障碍的随机对照研究.基于Cochrane 5.1偏倚风险评估工具对纳入进行文献质量评价,ADDIS软件和Stata 15.0软件进行网状meta分析.结果 共纳入21篇文献,涉及8种干预措施,包括1971例患者.康复+电针(MD=14.39,95%CI:4.14～24.92)、康复+雷火灸(MD=16.41,95%CI:1.68～31.38)、康复+头针(MD=16.94,95%CI:5.46～27.88)、康复+针刺(MD=13.28,95%CI:8.10～18.62)的Fugl-Meyer运动功能评估(FMA)总分高于单纯康复治疗(P＜0.05).康复+针刺、康复+艾灸、康复+穴位埋线的上肢FMA评分与单纯康复比较,差异无统计学意义(P＞0.05).康复+针刺(MD=3.52,95%CI:0.31～6.49)的下肢FMA评分高于单纯康复(P＜0.05).不同针灸疗法干预中风后运动功能障碍患者FMA总分的比较-校正漏斗图显示,部分研究远离中央位置,对称性较差,可能存在发表偏倚.纳入研究中仅有 1 篇提及不良反应发生情况,总发生率为 1.5%.结论 与单纯康复治疗比较,针灸相关的联合疗法对中风后运动功能障碍有更好的临床效果,未来还需要更多高质量的临床试验进行探究,以提供高质量循证医学证据.
Abstract
Objective To evaluate the effects of different acupuncture and moxibustion therapies on patients with post-stroke motor dysfunction by network meta-analysis.Methods PubMed,Embase,Cochrane,CNKI,Wanfang Data,and VIP were searched by computer for randomized controlled trials of acupuncture and moxibustion in the treatment of post-stroke motor dysfunction from the establishment of the database to October 2022.The quality of the included literatures was evaluated based on the Cochrane 5.1 tool for assessing bias risk.ADDIS software and Stata 15.0 software were used for network meta-analysis.Results A total of 21 literatures were included,involving eight interventions and 1 971 patients.The total Fugl-Meyer motor function assessment(FMA)scores of rehabilitation + electroacupuncture(MD=14.39,95%CI:4.14-24.92),rehabilitation + thunder-fire moxibustion(MD=16.41,95%CI:1.68-31.38),rehabilitation + head acupuncture(MD=16.94,95%CI:5.46-27.88),rehabilitation + acupuncture(MD=13.28,95%CI:8.10-18.62),and rehabilitation + acupuncture(MD=13.28,95%CI:8.10-18.62)were higher than that of rehabilitation alone(P＜0.05).There was no statisti-cally significant difference in the FMA scores of the upper limbs between rehabilitation + acupuncture,rehabilitation + moxibustion,rehabilitation + acupoint catgut embedding,and rehabilitation alone(P＞0.05).The FMA score of lower limbs of rehabilitation + acupuncture(MD=3.52,95%CI:0.31-6.49)was higher than that of rehabilitation alone(P＜0.05).The comparison of the total FMA scores of different acupuncture and moxibustion interventions in patients with post-stroke mo tor dysfunction showed that some studies were far from the central location and had poor symmetry,which may have publication bias.Only one of the included studies mentioned the occur-rence of adverse reactions,and the total incidence was 1.5%.Conclusion Compared with rehabilitation therapy alone,acupuncture and moxibustion combined therapy has better clinical effects on post-stroke motor dysfunction.More high-quality clinical trials are needed to provide high-quality evi-dence-based medical evidence in the future.
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