针灸疗法对稳定期慢性阻塞性肺疾病患者肺康复疗效的系统评价

Systematic Evaluation of Acupuncture and Moxibustion on Pulmonary Rehabilitation in Patients with Stable Chronic Obstructive Pulmonary Disease

目的系统评价针灸作为肺康复的重要手段在稳定期慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者的疗效,欲为针灸疗法在临床上的合理运用提供客观信息。方法对万方数据库、PubMed、中国生物医学文献网络版数据库、中国知网全文数据库、Cochrane、中国科技期刊数据库等检索从数据库建立至今有关针灸运用到慢性阻塞性肺疾病稳定期肺康复疗效的临床随机对照研究,然后进行必要的文献风险评估及质量评价,随后以RevMan5.3软件对纳入文献进行系统评价。结果荟萃分析结果显示共获得9篇关于针灸对稳定期慢性阻塞性肺疾病患者肺康复疗效的RCTs,纳入了681名患者。在肺功能方面针灸联合常规治疗明显优于西医常规治疗或者西医常规治疗联合安慰针:提高了肺功能FVC%[MD=5.90,95%CI(3.07,8.73),P <0.0001];改善FEV1指标[MD=0.32,95%CI(0.08,0.55),P=0.008];FEV1/FVC得到提高[MD=10.16,95%CI(4.34,15.99),P=0.0006];肺功能指标FEV1%也有较大改善[MD=0.93,95%CI(5.73,6.14),P <0.0001],以上对于肺功能的指标均具备统计学意义。此外6-minute walk distance及血气分析试验组也均优于对照组。无不良反应等安全性报告。结论针灸对稳定期慢性阻塞性肺疾病患者肺康复的肺通气功能、血气分析、6-minute walk distance等指标均有明显改善,而且安全性较好。

Objective To systematically analyze the efficacy of acupuncture and moxibustion as an important means of pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease.Methods Wanfang,PubMed,Chinese biomedical literature database online database,Chinese full text database,the Cochrane,China science and technology periodical database were used to retrieve clinical randomized controlled study on efficacy of acupuncture used in chronic obstructive pulmonary disease plateau pulmonary rehabilitation from database establishment to present,and then performed risk assessment and quality evaluation.Then RevMan5.3 software was used for meta-analysis research indicators.Results The results of the meta-analysis showed that a total of 9 papers of RCTs on the effects of acupuncture and moxibustion on pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease were included in 681 patients.In terms of lung function,acupuncture combined with conventional treatment is significantly better than western medicine combined with conventional treatment or western medicine combined with placebo acupuncture:improved lung function FVC%[MD=5.90,95%CI(3.07,8.73),P<0.0001],improved FEV1 index[MD=0.32,95%CI(0.08,0.55),P=0.008];improved FEV1/FVC[MD=10.16,95%CI(4.34,15.99),P=0.0006].Lung function indicators FEV1%were also significantly improved[MD=5.93,95%CI(5.73,6.14),P<0.0001].The above indicators of lung function were statistically significant.In addition,the observation group with 6-minute walk distance and blood gas analysis were better than the control group.No adverse reactions or other safety reports were found.Conclusion Acupuncture can significantly improve the pulmonary ventilation function,blood gas analysis,6-minute walk distance and other indexes in pulmonary rehabilitation of patients with stable COPD,and its safety is better.