电针治疗脑卒中后运动障碍疗效:一项随机对照试验的系统评价

Efficacy of Electroacupuncture for Post-stroke Motor Dysfunction:A Systematic Review of Randomized Controlled Trials

目的:系统评价电针对脑卒中后运动障碍患者的有效性和安全性。方法:计算机检索Pub Med、CNKI、VIP和CBM,搜索有关电针治疗脑卒中后运动障碍的随机对照试验,检索时限为建库至2015年11月;采用Cochrane系统评价员手册5.1.0推荐的方法,由2名研究者独立地完成文献筛选、资料提取及纳入研究的质量评价,并使用Rev Man 5.3软件进行Meta分析。结果:最终纳入符合标准的RCT研究12个,累计889例患者。Meta分析结果显示:在改善脑卒中患者FMA上肢部分评分[MD=-3.87,95%CI(-6.32,-1.42),P=0.002],FMA整体评分[MD=9.59,95%CI(8.93,10.24),P<0.000 01],BI评分[MD=8.91,95%CI(2.96,14.86),P=0.003]方面,电针组效果优于对照组;在改善脑卒中患者FMA下肢部分评分[MD=2.80,95%CI(-3.29,8.88),P=0.37],临床总有效率[RR=1.10,95%CI(0.94,1.29),P=0.22]方面,电针组与对照组相比差异均无统计学意义。结论:目前证据支持电针治疗脑卒中后运动障碍的有效性与安全性,电针可改善该类患者的运动功能及日常生活活动能力,但鉴于本次纳入研究质量偏低,仍需更多高质量的RCT以进一步验证其疗效。

Objective： To assess the efficacy and safety of electroacupuncture （EA） for the motor dysfunction after stroke. Methods： A systematical literature search including PubMed, China National Knowledge Infrastructure database （CNKI）, VIP medicine information system （VIP） and Chinese Biomedical Database （CBM） was conducted from the in- ceptions of the databases to November 2015. And the randomized clinical trials （RCTs） of EA treating stroke with motor dysfunction were researched in English and Chinese. Two review authors independently identified the studies based on the selection criteria. Besides, according to the Cochrane Reviewers＇ Handbook 5.1.0, two authors independently extracted the data and assessed the risk of bias for each included studies. All statistical analyses were conducted with RevMan 5.3 software. Results： Twelve eligible studies （889 participants） were eventually included in this review. Compared with con- trol groups ,2 RCTs showed significant effects of EA improving the upper extremity Fugl - Meyer scores （MD = -3.87, 95% CI - 6.32 to - 1.42, P = 0. 002） and 6 showed the evidence of EA increasing the Fugl - Meyer scores （ MD = 9. 59,95% CI 8.93 to 10.24,P 〈0. 000 01 ） and 9 showed significant effects of EA improving Barthe Index scores （ MD = 8.91,95% CI 2.96 to 14.86 ,P = 0.003 ）. However,3 RCTs showed no significant differences between EA groups and control groups in improving the lower extremity Fugl - Meyer scores （ MD = 2.80,95% CI - 3.29 tb 8.88 ,P = 0.37 ） and 3 RCTs showed no significant effects of EA favoring the clinical effective rate （ RR = 1. 10,95% CI O. 94 to 1.29, P = 0. 22）. Conclusions： At the moment, the evidence suggests that EA is effective and safe for recovery of patients with post - stroke motor dysfunction. And EA appears to be able to improve the motor function and activities of daily living af-ter stroke. However,because of generally low methodology of the included studies, further research with rigorous well - designed RCTs should be investigated .