推拿治疗小儿腹泻系统评价

Systematic Review of Randomized Controlled Trials of Massage Therapy for Infantile Diarrhea

目的比较推拿与西药治疗小儿腹泻临床疗效的差异。方法计算机检索中国生物医学文献数据库(CMB)、中国学术期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、Cochrane图书馆、PubMed和EMbase数据库,搜集有关推拿治疗小儿腹泻的随机对照试验(RCT)。由两名评价者独立提取资料并进行方法学质量评估,质量评价参照Cochrane系统评价员手册5.0.1标准,数据分析采用RevMan5.1软件。结果共纳入15个RCT。Meta分析结果显示,推拿治疗小儿腹泻疗效优于黏膜保护剂(思密达)[RR=1.22,95%CI(1.08,1.38)]和微生态制剂[RR=1.43,95%CI(1.13,1.82)]及黏膜保护剂与微生态制剂联合应用[RR=1.18,95%CI(1.09,1.29)];推拿治疗轮状病毒肠炎、抗生素相关性腹泻及其他类型腹泻疗效均优于西药。所有纳入的试验均未报告严重不良反应。结论推拿治疗小儿腹泻疗效优于西药,且对西医不同类型腹泻均存在一定优势。确切的结论尚需要设计更为严谨的大样本临床试验进行验证。

Objective To assess the different efficacy of massage therapy versus western medication for infantile diarrhea. Methods All randomized controlled trials （RCT s） of massage therapy for infantile diarrhea were searched from China Biomed- ical Literature Database on Disc （CBMdisc, 1978 to 2011）, China National Knowledge Internet （CNKI, 1979 to 2011）, VIP database （1989 to 2011）, Cochrane Library （Issue 10, 2011）, PubMed （1966 to 2011） and EMbase （1986 to 2011）. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. Cochrane Handbook for sys- tematic reviews 5.0.1 was taken as a reference to quality evaluation of the included studies and the Cochrane Collaboration＇s RevMan 5.1 software was used for data analysis. Results A total of 15 RCT s were included. The meta-analysis showed the efficacy of massage was superior to that of intestinal mucosa protector FRR= 1.22, 95 % CI （1.08, 1.38）-], microecological preparation [RR=1. 43, 95M CI （1.13, 1.82）3, or the combo therapy [RR=1. 18, 95% CI （1.09, 1.29）1. It also showed the efficacy of massage was superior to that of western medication for different subtypes of infantile diarrhea such as rotavirus enteritis and antibiotic-associated diarrhea. No adverse effect was reported in all the trials. Conclusion The efficacy of massage is superior to that of western medication for infantile diarrhea. However, the exact effect needs to be confirmed in well-de- signed and large-sampled clinical trials.