针灸治疗失语症临床文献的回顾性分析

Acupuncture for aphasia:a retrospective analysis of clinical literature

采用Meta分析评价针灸与其他常规方法治疗失语症的临床疗效,并探讨临床治疗失语症的选穴规律。检索中国期刊全文数据库、万方数据库、维普数据库、中国生物医学文献数据库公开发表的针灸治疗失语症临床随机对照研究文献,采用Cochrane协作网提供的Revman 5.2软件进行针灸与其他常规方法治疗失语症的临床疗效的统计分析;建立Microsoft Excel数据文件,采用频数分析的方法对纳入文献中的穴位使用情况进行分析,总结选穴特点及规律。共检索出文献385篇,符合纳入标准的37篇,获得病例数2 498例,其中针灸组1 260例,对照组1 238例。Meta分析结果显示OR=3.82,95%可信区间CI为[3.01,4.85],菱形位于竖线的右侧,漏斗图基本对称,提示针灸组对失语症的治疗效果优于对照组(Z=11.04,P<0.000 01);频数分析结果提示针灸治疗失语症腧穴出现的频次高低,频次在10次以上的穴位是:廉泉、通里、哑门、金津、玉液、百会、语言Ⅱ区、语言Ⅰ区、语言Ⅲ区,穴位归经出现的频次高低前五位的是:督脉、经外奇穴、任脉、手少阴心经、手阳明大肠经。认为针灸配合语言康复训练/药物治疗失语症的临床疗效优于单纯语言康复训练和药物,临床治疗失语症考虑穴位的近治作用,以头部及口颜面局部的穴位为主,选取督脉、经外奇穴、任脉上的穴位为多。

With the Meta-analysis method, the clinical efficacy of acupuncture and other regular methods for a phasia was evaluated, and the acupoints selection for aphasia was explored. The acupuncture literature of clinical randomized control trials for aphasia published in CNKI, WANFANG, VIP and CBM database was searched; the statistical analysis of clinical efficacy of acupuncture and other regular methods for aphasia was performed by using software Revman 5.2 provided by Cochrane library. A file of Microsoft Excel was established to perform the anal ysis of acupoints selection based on frequency analysis method, so as to summarize the characteristics and rules. Totally 385 articles were searched, and 37 articles those met the inclusive criteria was included, involving 1 260 patients in the acupuncture group and 1 238 patients in the control group. The Meta-analysis results showed OR= 3.82, 95% CI E3.01, 4. 851; rhombus was located on the right side and the funnel plot was nearly symmetry, in- dicating the treatment effect of the acupuncture group for aphasia was superior to the control group （Z= 11.04, P 〈0. 000 01 ）. The frequency-analysis results showed that the frequency of acupoints from top to bottom was Lian quan （CV 23）, Tongli （HT 5）, Yamen （GV 15）, Jinjin （EX-HN 12）, Yuye （EX-HN 13）, Baihui （GV 20）, Yuyan Ⅱ , Yuyan I and Yuyan Ⅲ. The frequency of meridians from top to bottom was the governor vessel, extra channels, conception vessel, heart meridian and large intestine meridian. It is concluded that the clinical efficacy of acupuncture combined with speech rehabilitation training and medication treatment for aphasia is superior to that of speech rehabilitation training and medication treatment alone. The clinical treatment for aphasia focuses on its local effect; the main acupoints are in the head and face, and the meridians are governor vessel, extra channels and con ception vessel.