针刺配合康复疗法治疗中风后痉挛的系统评价

Systematic Review of Acupuncture plus Rehabilitation for Post-Stroke Spasm

目的系统评价针刺配合康复疗法治疗中风后痉挛的疗效并总结常用穴位。方法采用计算机检索中国知网(CNKI)、万方数据库、维普网(VIP)等数据库自2005年1月1日至2014年12月31日国内所有针刺配合康复疗法治疗中风后痉挛的随机对照试验及半随机试验,并对符合纳入标准的研究进行评价。结果共纳入15个研究。Meta分析结果显示,针刺治疗中风后痉挛的最常用穴位有曲池、肩髃、合谷、天井、外关、足三里、三阴交、尺泽等。针刺配合康复疗法治疗中风后痉挛的有效率[OR=3.13,95%CI(2.00,4.89),P<0.00001]、基本治愈率[OR=2.42,95%CI(1.53,3.83),P=0.0002]、MAS评分[MD=-0.48,95%CI(-0.62,-0.35),P<0.00001]、FMA评分[MD=5.58,95%CI(4.96,6.20),P<0.00001]、BI指数[MD=10.46,95%CI(7.19,13.74),P<0.00001]及NDS评分[SMD=-0.68,95%CI(-0.91,-0.44),P<0.00001]均优于对照组,差异有统计学意义。结论针刺配合康复疗法可有效缓解中风后痉挛症状,值得临床推广;但纳入研究质量上存在一定缺陷,需要更多高质量的研究。

Objective To systematically review the therapeutic efficacy of acupuncture plus rehabilitation in treating post-stroke spasm and to summarize the commonly-used acupoints. Method The randomized controlled trials and quasi-randomized trials of acupuncture plus rehabilitation for post-stroke spasm published from January 1 of 2005 to December 31 of 2014 in China were retrieved from CNKI, Wan Fang database, and VIP database, etc. by using computer. The eligible studies were recruited for review. Result Totally 15 studies were enrolled. The Meta-analysis showed that the most commonly used acupoints in acupuncture treatment for post-stroke spasm were Quchi（LI 11）, Jianyu（LI 15）, Hegu（LI 4）, Tianjing（TE 10）, Waiguan（TE 5）, Zusanli（ST 36）, Sanyinjiao（SP 6）, Chize（LU 5）, and so on. Compared to the controls, acupuncture plus rehabilitation had significantly better effective rate [OR=3.13, 95%CI（2.00,4.89）,P〈0.00001], recovery rate [OR=2.42, 95%CI（1.53,3.83）,P=0.0002], MAS score [MD=﹣0.48, 95%CI（﹣0.62,﹣0.35）,P〈0.00001], FMA score [MD=5.58, 95%CI（4.96,6.20）,P〈0.00001], and NDS score [SMD=﹣0.68,95%CI（﹣0.91,﹣0.44）,P〈0.00001]. Conclusion Acupuncture plus rehabilitation can effectively mitigate the post-stroke spasm and is worth promoting in clinic; more high-quality researches are expected as the quality of the currently recruited trials is not so satisfactory.