穴位贴敷治疗阿片类药物所致便秘随机对照研究的Meta分析

Meta-analysis of Randomized Controlled Trials of Acupoint Application for Opioid-induced Constipation

目的系统评价穴位贴敷治疗阿片类药物所致便秘的有效性及安全性。方法计算机检索数据库,中文检索包括中国知网数据库(CNKI)、中国维普数据库(VIP)、中国生物医学数据库(CBM),英文检索PubMed,同时辅以手工检索,检索穴位贴敷治疗癌痛患者应用阿片类药物所致便秘的随机(RCT)对照试验。检索时限为2008年1月至2018年1月。分别由两名研究人员依据改良Jadad表对纳入的每个试验进行质量评估及偏倚风险评估,使用软件Stata13.0进行Meta分析。结果共纳入研究16个,总计1438例患者。穴位贴敷组治疗癌痛患者应用阿片类药物所致便秘的总有效率方面优于口服中成药组、空白或安慰剂组[口服中成药组OR=2.73,95%CI(1.53,4.88),Z=3.39,P<0.01;空白或安慰剂组OR=12.94,95%CI(7.85,21.34),Z=10.04,P<0.01]。以便秘总有效率做Harbord漏斗图显示无发表偏倚(P=0.720)。穴位贴敷组治疗阿片类药物所致便秘在总治愈率方面优于对照组[OR=2.24,95%CI(1.45,3.47),Z=3.63,P<0.01];可改善便秘症状总积分[SMD=﹣0.59,95%CI(﹣0.76,﹣0.42),Z=6.72,P<0.01];改善排便困难[SMD=﹣0.68,95%CI(﹣0.93,﹣0.43),Z=5.36,P≤0.01],缩短排便时间[SMD=﹣1.30,95%CI(﹣2.51,﹣0.10),Z=2.11,P=0.034]。结论穴位贴敷治疗癌症患者使用阿片类药物后所致便秘优于常规药物治疗,可改善排便困难,缩短排便时间。

Objective To systematically assess the efficacy and safety of acupoint application for opioid-induced constipation.Method A computer search of China National Knowledge Infrastructure(CNKI),China VIP database(VIP),Chinese BioMedical Literature Database(CBM)and PubMed was made with the help of manual searching to retrieve randomized controlled trials(RCT)of acupoint application for opioid-induced constipation in patients with cancer pain.The retrieval time limit was from January 2008 to January 2018.Two independent reviewers assessed the quality and bias risk of each included trial using the modified Jadad scale.A meta-analysis was made using Stata13.0.Result A total of sixteen studies were included with 1438 patients.The total efficacy rate for opioid-induced constipation was higher in the acupoint application group of patients with cancer pain than in the Chinese patent medicine,blank or placebo group[Chinese patent medicine group OR=2.73,95%CI(1.53,4.88),Z=3.39,P<0.01;blank or placebo group OR=12.94,95%CI(7.85,21.34),Z=10.04,P<0.01].The Harbord funnel plot of the total efficacy rate for constipation showed no publication bias.The total cure rate of opioid-induced constipation was higher in the acupoint application group than in the control group[OR=2.24,95%CI(1.45,3.47),Z=3.63,P<0.01].The total constipation symptom score could be improved[SMD=﹣0.59,95%CI(﹣0.76,﹣0.42),Z=6.72,P<0.01].Difficult defecation could be reduced[SMD=﹣0.68,95%CI(﹣0.93,﹣0.43),Z=5.36,P≤0.01].Defecating time was shortened[SMD=﹣1.30,95%CI(﹣2.51,﹣0.10),Z=2.11,P=0.034].Conclusion Acupoint application is more effective than conventional medication in treating opioid-induced constipation in patients with cancer pain.It can reduce difficult defecation and shorten defecating time.