针刺治疗卒中后手指拘挛meta分析

Meta-analysis on acupuncture for hand spasm post-stroke

目的 系统评价针刺/针刺联合康复训练对比单纯康复训练治疗卒中后手指拘挛的临床疗效。方法 采用计算机检索中国医院知识总库(CHKD)、中国知网(CNKI)、万方数据知识服务平台、维普数据库(VIP)、大医医学搜索、外文医学信息资源检索平台(FMRS)、Embase、PubMed和CochraneLibrary。检索从建库(刊)到2018年5月发表的关于针刺治疗卒中后手指拘挛的随机对照试验(RCT),对符合纳入标准的文献进行资料提取和质量评价,应用RevMan5.3统计软件对纳入的文献进行Meta分析。结果 最终纳入8项RCT,总计627例患者。Meta分析结果显示:①观察组与对照组相比,在改善卒中后手指拘挛患者痉挛程度(MAS)方面,差异有统计学意义[MD=-0.8,95%CI(-1.02,-0.59),P<0.00001],且观察组优于对照组;②观察组与对照组相比,在提高卒中后手指拘挛患者运动功能能力(FMA、Brunnstrom)方面,差异均具有统计学意义,FMA[MD=2.73,95%CI(2.08,3.38),P<0.00001];Brunnstrom[MD=0.54,95%CI(0.18,0.91),P=0.003],且观察组优于对照组;③观察组与对照组相比,在改善卒中后手指拘挛患者日常生活活动能力(MBI)方面,差异有统计学意义[MD=7.97,95%CI(3.54,12.4),P=0.004],且观察组优于对照组。结论 针刺/针刺结合康复训练与单纯康复训练相比,在改善卒中后手指拘挛患者痉挛程度、手运动功能以及日常生活能力方面均有积极的作用。由于纳入文献偏少且质量不高,存在偏倚风险,今后仍需设计更严格的随机对照临床试验进一步验证。

Objective To evaluate the clinical efficacy of acupuncture or acupuncture plus rehabilitation in treating post-stroke hand spasm by using the systematic review method The randomized controlled trials of acupuncture treatment for post-stroke hand spasm published from database(journal) establishment to May 1 of 2018 were retrieved from General library of knowledge in Chinese hospitals(CHKD),China national knowledge infrastructure(CNKI),Wan fang Database, VIP database,Da Yi Medical Search,Foreign Medical Literature Retrieval Service information Resources(FMRS),Embase,PubMed and the Cochrane Library.The required studies were extracted, then were evaluated and underwent meta-analysis by using Rev Man 5.3. Results Eight randomized clinical trials were finally recruited, including 627 subjects.The meta-analysis showed that:① Compared with control group,The difference was statistically significant in the improvement of MAS in post-stroke hand spasm patients,MAS[MD=-0.8,95%CI(-1.02,-0.59),P < 0.00001],the observation group was superior to the control group;② Compared with control group, there were also statistical significance in FMA and Brunnstr om between two groups FMA[MD=2.73,95%CI(2.08,3.38),P < 0.00001],Brunnstrom[MD=0.54,95%CI (0.18,0.91),P=0.003],the observation group was superior to the control group;③ Compared with control group, there were also statistical significance in MBI between two groups[MD=7.97,95%CI(3.54,12.4),P=0.004],the observation group was superior to the control group. Conclusion Compared with rehabilitation training,acupuncture or acupuncture combined with rehabilitation training has a positive effect on improving the degree of hand spasm, hand movement function and daily living ability of patients with hand spasm post-stroke. There is a risk of bias because of the limited quantities and samples. More high quality randomized controlled clinical trials will be needed to further verify.