针刺结合康复训练对脑卒中后吞咽功能障碍的疗效的系统评价与meta分析

Systematic evaluation and meta-analysis of the effect of acupuncture combined with rehabilitation training on dysphagia after stroke

目的系统评价针刺结合康复训练对比单纯康复训练或针刺治疗脑卒中后吞咽功能障碍的有效性,明确针刺结合康复训练的疗效是否优于单纯的康复训练或针刺治疗。方法计算机检索中国知网、万方数据、重庆维普、PubMed、Cochrance Library、Embase 6个数据库关于针刺结合康复训练治疗卒中后吞咽功能障碍的随机对照试验,检索时间限定为2010年1月1日—2018年12月31日。对检索文献进行纳入、排除、筛选后,采用RevMan 5.3软件进行meta分析。结果共纳入22项研究,包括1 987例患者。各研究的对照均为单纯的康复训练或康复训练结合假针刺,无单纯针刺为对照的研究。Meta分析结果显示:与单纯的康复训练治疗相比,针刺结合康复训练治疗脑卒中后吞咽功能障碍的有效率更高[17项研究,比值比=3.66,95%置信区间(confidence interval,CI)(2.66,5.05),P<0.000 01],治疗后视频透视吞咽功能检查评分更高[8项研究,均数差(mean difference,MD)=2.31分,95%CI(1.75,2.87)分,P<0.000 01],标准吞咽功能评定量表评分更低[6项研究,MD=-3.20分,95%CI(-3.78,-2.61)分,P<0.000 01],洼田饮水试验评分更低[6项研究,MD=-0.65分,95%CI(-0.91,-0.39)分,P<0.000 01]。结论针刺结合康复训练可有效治疗卒中后吞咽功能障碍,且疗效优于单纯康复训练。但受纳入文献质量和样本量限制,以上结果和结论仍需要高质量和大样本的研究加以验证。

Objective To systematically evaluate the effectiveness of acupuncture combined with rehabilitation training compared with simple rehabilitation training or acupuncture treatment of dysphagia after stroke,and make clear whether the effect of acupuncture combined with rehabilitation training is better than simple rehabilitation training or acupuncture treatment.Methods Six databases including China National Knowledge Infrastructure,Wanfang Data,Chongqing VIP,PubMed,Cochrance Library,and Embase were searched by computer for the randomized controlled trials on acupuncture combined with rehabilitation training treatment of post-stroke dysphagia,which were published from January 1 st,2010 to December 31 st,2018.After literature including,excluding,and screening,RevMan 5.3 software was used to conduct a meta-analysis.Results A total of 22 studies were included,including 1 987 patients.All the included studies took simple rehabilitation training or rehabilitation training combined with sham acupuncture as the control.Meta-analysis of efficiency and outcome measures for relevant studies showed that: compared with simple rehabilitation training,the effectiveness of acupuncture combined with rehabilitation training on post-stroke dysphagia was higher [17 studies included;odds ratio=3.66,95% confidence interval(CI)(2.66,5.05),P<0.000 01],the video fluoroscopy swallowing study score of acupuncture combined with rehabilitation training after treatment was higher[8 studies included;mean difference(MD)=2.31,95%CI(1.75,2.87),P<0.000 01],and the Standardized Swallowing Assessment score of acupuncture combined with rehabilitation training after treatment was lower [6 studies included;MD=-3.20,95%CI(-3.78,-2.61),P<0.000 01];at the same time the Watian Drinking Water Test score of acupuncture combined with rehabilitation training after treatment was lower [6 studies included;MD=-0.65,95%CI(-0.91,-0.39),P<0.000 01].Conclusions Acupuncture combined with rehabilitation training is effective in dysphagia after stroke,and the combined effect is better than simple rehabilitation training.However,due to the limitations of quality of included literature and sample size,the above results and conclusions still require high quality and large sample studies to testify.