中药外敷联合三阶梯止痛法治疗癌性疼痛的系统评价

A Systematic Review of External Applications Combined with Three- step Analgesic Therapy in Treating Cancer Pain

目的:系统评价中药外敷联合三阶梯止痛法治疗癌性疼痛的有效性以及安全性。设计相关随机对照试验(RCT)的系统评价。方法:计算机检索知网、万方、CBM、维普、Pub Med、Cochrane图书馆数据库和手工检索(时间截止至2015年11月),筛选符合纳入标准的RCT,依据Jadad量表进行质量评价,提取有效数据后采用Review Manager 5.3进行Meta分析。结果:最终11篇文献符合纳入标准,研究质量均低于3分,Meta分析结果显示能使患者疼痛缓解[RR=1.40,95%CI(1.28,1.52),P<0.00001];改善生活质量(卡氏)[WMD=6.45,95%CI(3.61,9.30),P<0.00001];降低不良反应发生率[OR=0.26,95%CI(0.17,0.40),P<0.00001];另外,各有1项研究显示中药外敷联合三阶梯止痛法能够改善VAS评分、爆发痛发作。结论:中药外敷联合三阶梯止痛法能进一步提高治疗癌性疼痛的疗效,但需要更多的高质量RCT来提高研究的水平。

Objective：To evaluate the safety and therapeutic effect of external applications （TCM） combined with three - step analgesic therapy in treating cancer pain. To design a systematic review of randomized controlled trials. Methods ： Methods ： Search databases as CNKI, Wanfang, CBM, VIP, PuhMed and Cochrane Library（ The search time was November 2015 ） relevant journals and the literature of RCTs of the combination of external applications and three - step analgesic therapy in treating cancer pain were all enrolled. The quality of RCTs was assessed using Jadad scores and extract the data. The Meta - analyses were performed with Review Manager 5.3 software. Results ： Eleven articles were enrolled. All articles scores were less than 3 points. The result of Meta - analyses showed that intervention measures could alleviate the cancer pain [ RR = 1.40,95% CI （ 1.28,1.52 ） , P 〈 0. 00001 ], improve the life quality （KPS） [ WMD = 6.45,95 % CI （ 3.61,9.30 ）, P 〈 0. 00001 ] and decrease the rate of adverse reactions [ OR = O. 26,95% CI （0. 17,0. 40 ）, P 〈 0. 00001 1. Besides, only two articles indicated that external applications com- bined with three -step analgesic therapy could improve VAS scores and decrease break -out pain attack. Conclusion：The combi- nation of external applications and three - step analgesic therapy would enhance the therapeutic effect of cancer pain. However, we need more high -quality RCTs to improve the research.