热敏灸治疗周围性面瘫临床疗效的系统评价

Clinical effect of heat-sensitive moxibustion in treating peripheral facial paralysis:A systemic review

目的:评价热敏灸治疗周围性面瘫的有效性和安全性。方法:电子检索CBM(1978年-2014年)、CNKI(1979年-2014年)、VIP(1989年-2014年)和Wanfang(1998年-2014年),并辅以手工检索,收集相关试验,按照Cochrane Handbook 5.0进行质量评估,统计学分析采用RevM an 5.3.4。结果:共纳入15篇文献,共计1 217例患者。Meta分析显示:总有效率:热敏灸+针刺VS针刺,RR=1.13,95%CI[1.04,1.21],差异具有统计学意义;热敏灸+针刺VS西药,差异无统计学意义;热敏灸+推拿VS西药,差异有统计学意义。愈显率:热敏灸VS针刺、热敏灸足三里+针刺VS艾灸翳风+针刺差异均具有统计学意义。有效率:热敏灸VS针刺差异无统计学意义。显效率:热敏灸翳风+针刺差异VS热敏灸下关+针刺有统计学意义。面神经功能评分:热敏灸VS针刺、热敏灸+针刺VS针刺、热敏灸翳风+针刺VS热敏灸下关+针刺均有统计学意义。不良反应:仅有1项试验交代治疗过程中有不良反应,其余试验均未描述不良反应情况。结论:热敏灸治疗周围性面瘫的疗效可能有一定的优势,但因纳入文献数量有限且质量较低,结论尚不确定,需要更多高质量、大样本、多中心、同期随机对照试验来进一步验证。

Objective：To evaluate the effectiveness and safety of heat-sensitive moxibustion in treating peripheral facial paralysis.Methods：Randomized controlled trials（RCTs） involved in CBM（1978 to 2014）,CNKI（1979 to 2014）,VIP（1989 to2014）,Wanfang database（1998 to 2014）were searched by electronic and manual retrieval.The quality of each RCT was assessed in accordance with the Cochrane Handbook 5.0.The data was analyzed by using RevMan 5.3.4 software.Results：A total of15 trials involving 1 217 patients were included.Meta-analysis showed that the difference in total effective rate between heatsensitive moxibustion combined with acupuncture therapy and acupuncture therapy was significant（RR= 1.13,95%CI[1.04,1.21]）,the difference between heat-sensitive moxibustion combined with acupuncture therapy and western medicine therapy was not significant,and the difference between heat-sensitive moxibustion combined with manipulation therapy and western medicine therapy was significant.The differences in cure-remarkable-effectiveness rate between heat-sensitive moxibustion therapy and acupuncture therapy,and combination of heat-sensitive moxibustion on Zusanli（ST36） and acupuncture in Yifeng（SJ17）therapy and combination of moxibustion on Yifeng（SJ17）and acupuncture therapy were significant.The difference in effective rate between heat-sensitive moxibustion therapy and acupuncture was not significant.The difference in obvious effective rate between combination of heat-sensitive moxibustion on Yifeng（SJ17） and acupuncture therapy and combination of heat-sensitive moxibustion on Xiaguan（ST7） and acupuncture therapy was significant.The difference in score of facial nerve function between heat-sensitive moxibustion therapy and acupuncture therapy,combination of heat-sensitive moxibustion and acupuncture therapy and acupuncture therapy,combination of heat-sensitive moxibustion on Yifeng（SJ17） and acupuncture therapy and combination of heat-sensitive moxibustion on Xiaguan（ST7） and acupuncture therapy was significant.There was only one study reported the untoward effect.Conclusion：Heat-sensitive moxibustion has certain superiority in treating facial paralysis.The number of RCTs included is few,and the quality is not high,so that the conclusion needs to be verified by large sample,multicenter,randomized,double-blind controlled clinical trials designed properly and scientifically.