针刺治疗脊髓损伤后尿潴留的Meta分析

Acupuncture treatment for urinary retention following spinal cord injury: a Meta-analysis

背景:针刺是治疗脊髓损伤后尿潴留的常用方法,因其不良反应小、操作简便,被广泛应用于脊髓损伤后尿潴留的临床治疗中。但目前仍缺乏循证医学证据。目的:对针刺治疗脊髓损伤后尿潴留的随机对照试验进行系统评价和Meta分析,以明确针刺干预的疗效。方法:计算机检索中国生物医学、中国知网、万方、Cochrane Library、Pub Med、EMBASE、Web of Science数据库,检索时间均从建库至2017年3月。中文检索词包括"脊髓损伤、尿潴留、针刺";英文检索词包括"spinal cord injury,neurogenic bladder,acupuncture"。纳入针刺或针刺联合常规治疗与单纯常规治疗相比较的随机对照试验,采用RevM an 5.3软件进行Meta分析。结果与结论:(1)研究共纳入9个随机对照试验,632例患者;(2)Meta分析结果显示:在尿动力学方面,针刺治疗对患者残余尿量[MD=-144.26,95%CI(-252.15,-36.37),P=0.009]及最大膀胱容量[MD=35.69,95%CI(3.15,68.22),P=0.03]的改善效果均优于对照组,差异有显著性意义;(3)在排尿次数方面,针刺干预对患者日平均排尿次数的改善效果与对照组相比较,差异无显著性意义[MD=-1.66,95%CI(-3.40,0.07),P=0.06];(4)在总有效率方面,针刺干预脊髓损伤后神经源性膀胱患者的疗效优于对照组,差异有显著性意义[RR=1.24,95%CI(1.11,1.37),P<0.0001];(5)结果提示:与常规治疗相比,针刺能更为有效地改善脊髓损伤后尿潴留患者的残余尿量、最大膀胱容量,提高治疗总有效率。

BACKGROUND:Acupuncture is a common treatment for urinary retention after spinal cord injury.It has been widely used in the clinical treatment of urinary retention after spinal cord injury due to its small side effects and simple operation.However,there is a lack of evidence-based medicine.OBJECTIVE:To examine the effectiveness of acupuncture for urinary retention in patients with spinal cord injury by a systematic review and Meta-analysis of randomized controlled trials(RCTs).METHODS:A computer-based online retrieval of CBM,CNKI,WanFang,Cochrane Library,PubMed,EMBASE,and Web of Science databases was performed.The keywords were“spinal cord injury,neurogenic bladder,acupuncture”in English and Chinese,respectively.RCTs concerning acupuncture or acupuncture combined with conventional therapy were identified and a Meta-analysis was conducted on RevMan 5.3 software.RESULTS AND CONCLUSION:Nine RCTs involving 632 participants were included.In terms of urodynamic changes,compared with the control group,acupuncture was more effective in improving the residual urine volume[mean difference(MD)=-144.26,95%confidence interval(CI)(-252.15,-36.37),P=0.009]and maximum cystometric capacity[MD=35.69,95%CI(3.15,68.22),P=0.03].However,there were no significant differences between two groups for average daily number of urination[MD=-1.66,95%CI(-3.40,0.07),P=0.06].Concerning total effective rate,acupuncture was more effective than control group[RR=1.24,95%CI(1.11,1.37),P<0.0001].To conclude,compared with the conventional therapy,acupuncture is more effective in improving residual urine volume,maximum cystometric capacity and total effective rate for urinary retention in patients with spinal cord injury.