针刺联合康复训练治疗卒中后吞咽功能障碍的循证医学研究

Acupuncture Combined with Rehabilitation Training in Treatment of Post-Stroke Dysphagia:An Evidence-Based Medicine Study

目的:探讨针刺联合康复训练治疗卒中后吞咽功能障碍的循证医学研究。方法:以"针刺""康复训练"和"卒中后吞咽功能障碍"为主题词或关键词,检索CNKI、万方、维普等数据库,以"Acupuncture""Rehabilitation training""Dysphagia after stroke"为主题词或关键词,检索Pub Med数据库,期限为2005年—2017年,收集关于针刺联合康复训练治疗卒中后吞咽功能障碍的RCT文献,采用Review Manager5.2进行分析。结果:共12篇文献纳入研究,文献质量偏低。治疗组527例,采用针刺联合康复训练;对照组485例,采用康复训练或神经内科常规治疗。治疗有效率分析采用Fixed Effect模型,Odds Ratio=3.80,Z=6.77(P<0.000 01),95%CI(2.58,5.60),菱形图位于右侧,说明治疗组患者治疗有效率显著升高。文献均匀的分布在虚线两侧,小部分文献呈倾斜状态,表明存在发表性偏倚。洼田饮水试验分析采用Random Effects模型,Mean Difference=-0.98,Z=5.02(P<0.000 01),95%CI(-1.14,-0.50),菱形图位于左侧,说明治疗组患者洼田饮水试验评分显著降低。结论:Meta分析结果提示针刺联合康复训练治疗卒中后吞咽功能障碍的有效率显著升高,降低吞咽困难程度,但由于本次纳入文献质量普遍偏低,导致结果的可信度有所商榷,临床需谨慎使用,需要更高质量RCT文献来证实。

Objective： To explore the evidence-based medicine study of acupuncture combined with rehabilitation training in treatment of post-stroke dysphagia. Methods： RCT literatures on post-stroke dysphagia treated by acupuncture combined with rehabilitation training were retrieved with the index words of ＂Acupuncture＂,＂Rehabilitation training＂,and ＂Dysphagia after stroke＂from databases of CNKI,Wan Fang,VIP,and Pub Med during the period of 2005-2017. Review Manager 5. 2 was used to do the analysis. Results： A total of12 literatures were included in the study,and the quality of the literatures was quite low. There were 527 cases in the treatment group treated with acupuncture combined with rehabilitation training,and 485 cases in the control group treated with rehabilitation training or neurology routine treatment. The effective rate was analyzed by Fixed Effect model,Odds Ratio = 3. 80,Z = 6. 77（ P 0. 000 01）,95% CI（ 2. 58,5. 60）,diamond figure was on the right side,indicating that the effective rate of the treatment group was significantly higher. The literatures were evenly distributed on both sides of the dotted line,and only a small part of the literatures were tilted,indicating that there was a publication bias. The drinking water test was analyzed by Random Effects model,Mean Difference =-0. 98,Z = 5. 02（ P 0. 000 01）,95% CI（-1. 14,-0. 50）,and diamond figure was on the left side,indicating that the score of drinking water test was significantly lower in the treatment group. Conclusion： Meta analysis showed that acupuncture combined with rehabilitation training increased the efficacy and reduced the degree of dysphagia in treatment of post-stroke dysphagia. However,the credibility of the results was questionable because of the low-quality literatures included; more higher-quality RCT literatures needed for further confirmation.