单纯针刺促进腹部术后胃肠功能紊乱恢复的Meta分析

Meta-analysis of Simple Acupuncture to Promote Postoperative Abdominal Gastrointestinal Dysfunction Recovery

目的:评价单纯针刺或其配合术后常规治疗促进腹部术后胃肠功能紊乱恢复(PGD)的有效性和安全性。方法:计算机检索2007年1—12月发表在万方数据库、中国期刊网全文数据库、重庆维普数据库、Pub Med和Cochrane Library的有关单纯针刺或单纯针刺配合术后常规治疗腹部术后胃肠功能紊乱的临床随机对照研究,对符合纳入标准的文献进行资料提取和质量评价,应用Rev Man5. 2统计软件对纳入的文献数据进行Meta分析。结果:1)共纳入18篇文献,其中中文文献17篇,英文文献1篇,合计1 621例术后胃肠功能紊乱患者。2) Meta分析结果显示:9项研究在总有效率方面:与术后常规治疗比较,单纯针刺或配合术后常规治疗对PGD更有效,差异有统计学意义,异质性检验P=0. 001,I2=69%,合并效应量RR=1. 15> 1,95%CI[1. 06,1. 25],P=0. 0006,敏感性分析异质性检验P=0. 22,I2=26%,合并效应量RR=1. 16>1,95%CI[1. 09,1. 24],P <0. 00001; 16项研究在缩短术后首次排气时间方面,差异有统计学意义异质性检验P <0. 00001,I2=98%,合并效应量MD=-17. 52,95%CI[-22. 85,-12. 19],P <0. 00001,经敏感性和亚组分析未发现异质性来源; 12项研究在缩短术后首次排便方面,差异有统计学意义异质性检验P <0. 00001,I2=95%,合并效应量SMD=-1. 61,95%CI[-2. 29,-0. 93],P <0. 00001,经敏感性分析和亚组分析未发现异质性来源; 12项研究在缩短术后肠鸣音恢复时间方面,差异有统计学意义P <0. 00001,I2=92%,采用随机效应模型,SMD=-1. 33,95%CI[-1. 82,-0. 85],P <0. 00001,经敏感性和亚组分析未发现异质性来源。结论:单纯针刺或其配合术后常规治疗可以有效促进患者术后胃肠功能紊乱的恢复,但由于此次纳入文献的证据质量等级不高,故需谨慎对待此结论,仍需要临床大样本,多中心,高质量的随机对照试验进行进一步的验证。

Objective ：To evaluate the efficacy and safety of acupuncture alone or its combination with routine postoperative treatment to promote the recovery of abdonfinal postoperative gastrointestinal dysfunction （PGD）. Methods ：The references of random- ized controlled trials or clinical control trials of simple acupuncture or its combination with postoperative conventional therapy in promoting the recovery of PGD were searched from Wanfang, CNKI, VIP, PubMed and Coehrane Library Database published from January 2007 to December 2017. The data that meet the inclusion criteria were extracted and quality evaluated. Revman 5.2 was used for the meta-analysis. Results ： 1 ） A total of 18 papers involving 1621 patients were included, of which 17 were in Chinese and 1 was in English. 2） The results of the meta-analysis indicated that：Compared with postoperative conventional treatment,the total effective rate of 9 studies showed acupuncture alone or its combination with postoperative conventional therapy in treatment of PGD was more effective, the difference was statistically significant （ P = 0. 001, I^2 = 69%, RR = 1.15,95% CI [1.06,1.25] , P =0. 0006,Sensitivity analysis ：P = 0. 22,12 = 26%, RR = 1.16 〉 1,95 % CI [ 1.09,1.24], P 〈 0. 00001 ） ; There were statistically significant differences in 16 studies in shortening the first flatus time （P 〈0. 00001 ,I^2 =98% ,MD = - 17. 52,95% CI[ -22. 85, - 12. 191 ,P 〈 0. 00001 ） ; There were statistically significant differences in 12 studies in shortening the first defecation time （P 〈 0. 00001,12 = 95% , SMD = - 1.61,95% CI [ -2. 29, -0. 93], P 〈 0. 00001 ） ; There were statistically significant differences in 12 studies in shortening the bowel sounds recovery time （P 〈 0. 00001 ,I^2 = 92% , SMD = - 1.33,95 % CI [ - 1.82, - 0. 85] ,P 〈 0. 00001 ）. Conclusion ： Acupuncture alone or its combination with postoperative conventional therapy can effectively promote the recovery of postoperative gastrointestinal disorders. However, because of the limited quantity and quality of the studies included, the conclusion above still needs to be verified by conducting more high-quality studies.