针灸治疗排粪失禁规律分析及研究质量评价

Analysis and research quality evaluation of acupuncture and moxibustion treatment for fecal incontinence

目的:基于文献分析针灸对于排粪失禁的治疗规律并评估总体研究质量。方法:检索1977年至2017年期间万方数据库、维普医学资源数据(VIP)、中国期刊全文数据库和PubMed数据库中针灸治疗排粪失禁的有关文献。提取文献中取穴、治法、观察指标、近期及远期疗效等信息进行汇总分析。结果:共纳入临床研究文献22篇,共纳入患者1588例,其中最大样本500例,最小15例,中位样本数39例。共使用穴位50个,涉及经脉13条,常用穴位:足三里、肾俞、长强、次髎、气海等。其中属膀胱经者13穴(26%),任脉8穴(16%),督脉5穴(10%),脾经、胃经各4穴(8%),大肠经、心包经及肾经各2穴(4%)。针灸方法方面,针刺16篇(72.7%),电针7篇(31.8%),灸法6篇(27.3%),其它针灸方法6篇(27.3%),多种针灸方法或者疗法联合治疗的方式最为常见。临床总有效率70%~100%。研究质量方面,11篇报道(50%)采用了肛门失禁评分、肛门直肠压力测定等客观指标,13篇文章(59.1%)的疗效评价标准存在缺陷。结论:临床上针灸常以温补为法治疗排粪失禁,穴位主要集中在膀胱经及任督二脉。治疗方法较多,常多法联用,临床疗效相对满意。但是目前有关临床研究较少,质量欠佳,一些研究仍然存在设计不合理的情况。

Objective:To analyze the law of acupuncture treatment for fecal incontinence and assessed the general quality of the studies based on literature analysis.Methods:Related literatures of acupuncture treatment for fecal incontinence published from 1977 to 2017 were retrieved in China Journal Full-text Database,Wanfang Database,VIP Medical Resource Data(VIP)and PubMed.The information of acupoint selection,treatments,observation index,short-term and long-term effects were extracted and analyzed.Results:A total of 22 clinical studies were included.And 1 588 patients were enrolled,the sample size ranged from 15 to 500 cases with a medium sample of 39 cases.Fifty points were found involving 13 channels.The most frequent acupoints includes:Zusanli(S36),Shenshu(B23),Changqiang(GV1),Ciliao,Qihai(CV6),and so on.Thirteen points(26%)located in the bladder channel,8 points(16%)in ren channel,5 points(10%)in Du channel,4 points(8%)in each channel of spleen and stomach,and 2 points(4%)in each channel of Dachang,Xinbao and Kindney.The needle acupuncture method is reported in 16(72.7%)articles,electro-acupuncture in 7(38.1%)articles,moxibustion in 6(27.3%)articles,other methods in 6(27.3%)articles.A variety of acupuncture methods or therapies are often used in combination in clinical practice.The total effective rates ranged from 70%to 100%.In research quality,eleven reports(50%)adopted the objective indexes such as Fecal Incontinence Score or anorectal manometry,and the evaluation standards of the efficacy were found be lack of scientific in 13(59.1%)articles.Conclusion:Warming was frequently used in acupuncture treatment for fecal incontinence.The acupoints mainly located in bladder,Ren and Du channels.The treatment methods are diverse and often combined.The clinical effective rates are satisfied.However,there are few clinical studies and poor quality,and some studies still have unreasonable design.