得气对原发性痛经患者经穴效应影响的随机对照试验系统综述

Impact of deqi on acupoint effects in patients with primary dysmenorrhea: a systematic review of randomized controlled trials

系统评价得气对原发性痛经(PD)患者经穴效应的影响。检索国内外10个文献数据库,包括中国知网(CNKI)、维普数据库(VIP)、万方数据库、中国生物医学文献数据库(CBM)、Cochrane图书馆(Cochrane Library CENTRAL)、MEDLINE数据库、荷兰医学文摘数据库(Embase)、联合补充医学文献数据库(AMED)、护理学及医疗相关文献累计索引数据库(CINAHL Plus)、精神医学信息数据库(Psyc INFO),补充检索5个临床试验注册库、论文后参考文献和灰色文献网站Open Grey。时间从建库至2016年8月,没有语种和发表状态限制。收集单纯针刺经穴得气对比不得气或不同得气要素治疗PD的随机对照试验(RCTs)和半随机对照试验(q-RCTs)。研究质量按照Cochrane偏倚风险评估工具5.1.0评价。若研究间临床异质性小且I 2≤75%,采用Rev Man 5.3.5进行定量综合,否则进行定性综合。纳入6项随机对照试验(RCTs),共645例患者。因临床异质性大只进行定性综合,(1)针刺经穴得气或不得气均具有缓解疼痛和焦虑的效应;得气时缓解疼痛的效应优于不得气时或与不得气时相当,得气时缓解焦虑的效应与不得气时无差异。(2)得气程度越高、穴位数越多,针刺经穴在缓解疼痛、减轻症状和减少疼痛时间方面的效应越好;(3)得气率越高,针刺经穴缓解焦虑的效应越好,但缓解疼痛的效应无变化;(4)得气出现越快并且气至病所,针刺经穴缓解疼痛的效应起效越快;(5)有温热得气感或有传导放射至病所的温热得气感,针刺经穴缓解疼痛和症状的效应越好。由于纳入研究数量少、质量不高以及潜在的偏倚,故还不能明确得气对PD患者经穴效应的影响如何。本研究方案已在PROSPERO平台注册:CRD42016038518。

The effects of deqi（arrival of qi） on acupoint effects in patients with primary dysmenorrhea（PD） were evaluated. Ten literature databases, including China National Knowledge Infrastructure（CNKI）, VIP Database, Wanfang Database, Chinese Biomedical Literature Database（CBM）, Cochrane Library CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus, Psyc INFO were selected. In addition, 5 registers of ongoing trials, the reference lists of included articles and grey literature website Open Grey were added. The search time was from date of database establishment to August 2016; no restrictions were made on language or status of publication. All randomized controlled trials（RCTs） and quasi-randomized controlled trials（q-RCTs） which compared the effects of deqi and non-deqi on PD or compared the effects of different deqi elements on PD were included. The research quality was assessed according to Cochrane bias risk evaluation tool 5.1.0. The Rev Man 5.3.5 was applied for quantitative analysis if insignificant clinical heterogenicity with I2≤75%, otherwise the results was summarized by qualitative analysis. As a result, 6 RCTs involving 645 patients were included. Because of considerable clinical heterogeneity, only qualitative analysis was performed, which indicated（1） acupuncture could reduce pain and anxiety regardless of deqi, and the effects of deqi on pain relief were superior or equivalent to that of none-deqi, and the effects of deqi on anxiety relief were similar to that of none-deqi;（2） the more intensity of deqi and higher number of acupoints selected, the better effects on pain alleviation, symptom relief and pain duration;（3） the higher rate of deqi had a better acupoint effect on alleviating anxiety, but was not on pain relief;（4） deqi appeared early and propagated to affected area could lead to faster onset on pain relief;（5） the effects on relieving pain and symptoms was better when warm sensation in deqi or qi reaching affected area. Due to the few number, low quality and potential bias of included studies, it was not sufficient to draw clear conclusion regarding the effects of deqi on PD patients. This study protocol was registered in PROSPERO（CRD42016038518）.