艾灸至阴穴治疗胎位不正临床疗效的Meta分析

Meta-analysis of Efficacy of Moxibustion at Zhiyin Point for Breech Presentation

目的系统评价单纯艾灸至阴穴或配合膝胸卧位治疗胎位不正的临床疗效。方法电子检索 PubMed、Cochrane library、CNKI、VIP、万方和CBM,检索时间限定为自建库至2017年6月15日,检出所有艾灸至阴穴或配合膝胸卧位治疗胎位不正的有关文献,2名研究员独立严格进行纳入研究的质量评价和资料提取,用Stata 14软件进行Meta分析,用TSA v0.9软件进行试验序贯分析。结果纳入符合要求的文献 12篇,共2331例患者。meta分析表明:与膝胸卧位相比,单纯组胎位转正率增加44%[RR=1.44,95%C(I 1.33, 1.55),P<0.001],配合组胎位转正率增加35%[RR=1.32,95%C(I 1.22,1.42),P<0.001],都存在统计学意义。亚组分析提示,单纯组或配合组胎位转正率均与疗程和艾灸时间有关,且两组均对30-34周妊娠妇女疗效最佳。试验序贯分析提示艾灸至阴穴或配合膝胸卧位的疗效显著。结论单纯艾灸至阴穴或配合膝胸卧位均能增加胎位不正的胎位转正率,且单纯艾灸至阴穴纠正胎位不正的效果更佳,两组均对30-34妊娠周数的孕妇疗效最佳,值得临床推广。

Objective To systematically evaluate the clinical efficacy of moxibustion at Zhiyin point alone or in combination with knee-chest decubitus position in treatment of fetal malposition. Methods PubMed,Cochrane library,CNKI,VIP,Wanfang and CBM were searched electronically. The search time was limited to June 15,2017. All relevant literatures about moxibustion at Zhiyin point or treatment of fetal malposition with knee-chest decubitus position were detected. Two researchers independently and strictly carried out quality evaluation and data extraction for the study. Meta-analysis was carried out with Stata 14 software, and sequential analysis was carried out with TSA v0.9 software. Results Totally 2331 patients were included in 12 eligible lit- eratures. Meta-analysis showed that compared with knee-chest decubitus position,the positive rate of fetal position in simple group increased by 44%[RR=1.44,95%CI(1.33,1.55),P<0.001],while that in combined group increased by 35%[RR=1.32, 95%CI(1.22,1.42),P<0.001],all with statistical significance. Subgroup analysis showed that the positive rate of fetal position in simple group or combined group was related to the course of treatment and moxibustion time,and both groups had the best curative effect on pregnant women with 30~34 gestational weeks. Sequential analysis of the tests indicated that moxibustion at Zhiyin point or combined with knee-chest decubitus was effective. Conclusion Moxibustion at Zhiyin point alone or combined with knee-chest decubitus position can increase the rate of positive fetal position,and moxibustion at Zhiyin point alone has better effect on correcting abnormal fetal position. Both groups have the best effect on pregnant women with 30~34 gestational weeks,which is worthy of clinical promotion.