摘要
Objective： To observe the clinical efficacy of electroacupuncture at facial acupoints combined with electrical stimulation on the auricular vagus nerve points for treatment of chloasma.Methods： Sixty patients with chloasma were selected. According to acupoint selection along facial nerve trunk initially created by professor Gao Wei-bin, Yifeng（翳风TE 17）, Shangguan（上关GB 3） Sizhukong（丝竹空 TE 23）,temporal branches, Xiaguan（下关 ST 7） Sibai（四白 ST 2）,zygomatic branches, Qianzheng（牵正）Quanliao（颧髎 SI 18）,zygomatic branches, Jiache（颊车 ST 6） Chengjiang（承浆 CV 24）,buccal branches, and Hegu（合谷 LI 4）. The auricular vagus nerve acupoints was added additionally（two distribution points in each cavity of auricular concha were selected）. Electroacupuncture was conducted for30 min/time, once a day, and 6 times/week. One day was free from treatment between 2 weeks. Treatment for 4 weeks was 1 course of treatment, and the effect was observed after 1 course.Results： Cured： 39 cases, markedly effective： 13 cases, effective： 6 cases, ineffective： 3 cases. The cure rate was 65%, and the total effective rate was up to 95.0%.Conclusion： The curative effect of electroacupuncture at facial acupoints combined with electrical stimulation on the auricular vagus nerve points for treatment of chloasma was satisfactory.
目的：评价远端取穴、近端取穴、远近端相结合取穴对针刺疗效的影响。方法：遵循循证医学（EBM）要求,对国内外相关医学文献数据库近20年来有关针刺远近取穴的文献进行了检索,并对纳入的文献进行Meta分析。结果：最终纳入文献32篇,共计患者2829例。Meta分析结果表明,在针灸治疗疾病的过程中远近配穴方法疗效要优于单纯的远端或近端取穴治疗,且单纯的远、近取穴治疗并无明显的疗效差别。对其中纳入的18篇文献综合分析,近端选穴与远端选穴的总有效率差异无统计学意义,即针刺近端选穴与远端选穴的疗效相当[OR=0.83,95%CI（0.83,1.18）,Z=1.04,P〉0.01]。对其中纳入的20篇文献综合分析,近端选穴与远近选穴的总有效率差异有统计学意义,即结果显示针刺远近选穴疗效优于近端选穴[OR=0.32,95%CI（0.23,0.44）,Z=6.90,P〈0.01]。对其中纳入的8篇文献综合分析,远端选穴与远近选穴的总有效率差异有统计学意义,即结果显示针刺远近选穴疗效优于远端选穴[OR=0.20,95%CI（0.10,0.40）,Z=4.50,P〈0.01]。另外,本研究的发表偏倚分析提示可能存在发表偏倚。由于纳入的文献质量普遍偏低,上述结论仍需更多高质量的循证医学证据支持。结论：在针刺治疗中,远近配穴作用要优于单纯的远端或近端取穴治疗,而单纯的远端取穴与单纯近端取穴相比,并无明显的疗效差别。
基金
Supported by Postgraduate innovative research project of Heilongjiang Univer-sity of Chinese Medicine:yjscx2017032~~
