针灸治疗卒中后吞咽困难的系统评价

Systematic evaluation on acupuncture and moxibustion for treatment of dysphagia after stroke

目的评价针灸治疗卒中后吞咽困难的疗效及可能的不良反应。方法对针灸治疗卒中后吞咽困难的随机对照试验(RCT)或半随机对照试验(quasi-RCT)按Cochrane协作网推荐的方法进行系统评价。结果7篇中文文献506例患者满足纳入标准,均为低质量试验。纳入的6个试验Meta-分析结果表明针刺对卒中后吞咽困难的疗效优于对照组[RR1·17,95%CI(1·08,1·27),Z=3·78,P=0·0002]。病死率、肺部感染率针刺组与非针刺组无差异[分别是RR0·25,95%CI(0·03,2·18)和RR3·02,95%CI(0·39,23·10)]。电视透视检查(VF)示在常规治疗基础上针刺对比康复训练可缩短胶钡咽通过时间[WMD-7·23,95%CI(-13·18,-1·28)]。结论由于纳入研究数量和质量上的缺陷,尤其是缺乏远期功能性结局指标,虽显示针刺有短期改善卒中后吞咽困难的趋势,无不良反应,但目前尚不能对其疗效得出肯定结论。开展更多高质量、内在真实性好的大规模、多中心的RCT非常必要。

Objective To assess the therapeutic effect and potential adverse effect of acupuncture in treatment of dysphagia after stroke. Methods A systematic review including all the relevant randomized controlled trials （RCTs） or quasi-RCTs of acupuncture and moxibustion for treatment of dysphagia after stroke were performed using the method recommended by the cochrane collaboration, Results Seven papers including 506 cases met the enrolled criteria. All of the trials were of lower methodological quality. Meta-analysis of enrolled 6 trials showed that the acupuncture group had a better therapeutic effect on dysphagia after stroke than the control group （RR 1.17, 95 % CI 1.08, 1.27, Z=3.78, P=0. 0002）. The mortality and the occurrence of pneumonia were similar between acu puncture and control groups （RR O. 25, 95% CI 0. 03, 2.18 and RR 3.02, 95% CI 0. 093, 23. 10, respectively）. The treatment group significantly reduced in time of the thick barium through pharynx examined by videofluorogra. phy（WMD -7.23, 95%CI -13.18,-1.28）. Conclusion A reliable conclusion can not be drawn from the present data because of the defects in methodological quality, especially no long-term terminal outcome events, although it appears a tendency that acupuncture can improve dysphagia after stroke in short-term with no adverse effect. Therefore, it is necessary to perform more multi-central randomized controlled trials in good internal validity and high quality in future.