耳穴疗法对血液透析患者失眠影响的网状meta分析

Network Meta-Analysis on Ear Acupuncture for Hemodialysis Patients with Insomnia

目的:运用网状Meta的分析方法评价耳穴疗法、舒乐安定、艾司唑仑、中药沐足治疗血液透析患者失眠的临床疗效。方法:检索CNKI、CBM、VIP、wanfang、PubMed、EMbase,检索时限均从建库至2018年10月1日。2位研究者按照Cochrane手册5.1.0标准独立对每项纳入的研究方法学质量进行偏倚风险评估。数据采用Revman和R软件进行数据分析处理。结果:最终共纳入11项研究(817例患者)。网状meta分析结果显示耳穴疗法VS舒乐安定(OR=3.10,95%CI[1.42,4.78])、耳穴疗法VS常规治疗(OR=5.35,95%CI[5.19,5.50])、耳穴疗法VS中药足浴+耳穴疗法(OR=-2.25,95%CI[-3.07,-1.14])、耳穴疗法VS耳穴疗法+艾司唑仑(OR=-1.80,95%CI[-3.20,-0.40]),分析得出在治疗血液透析失眠方面,耳穴疗法优于舒乐安定和艾司唑仑,艾司唑仑优于舒乐安定,中药沐足联合耳穴疗法的疗效还需要进一步验证。结论:耳穴疗法治疗血液透析患者失眠相对于现在的各种中西医疗法而言简单有效,基于现有研究的局限性,确切的结论仍需要高质量的RCT研究来验证。

Objective:This paper assessed the effectiveness of five methods ear acupuncture、estazolam、surazepam、chinese medicine bath-foot, and conventional therapy for hemodialysis patients with insomnia with network meta-analysis.Methods:The research used databases including the CNKI, CBM, VIP, WanFang, PubMed, Embase and CENTRAL from their respective inceptions to 1 Oct2018. The assessment of quality and risk of bias of each experiment was carried out by 2 researchers independently in accordance with the Cochrane Handbook 5.1.0 standard. Then meta-analysis was performed with Revman and R software.Results:The research performed 11 trials(817 patients) in total.The results of network meta-analysis indicated the following: Ear Acupuncture VS Surazepam(OR=3.10, 95%CI[1.42,4.78])、Ear Acupuncture VS Conventional therapy(OR=5.35, 95%CI[5.19,5.50])、Ear Acupuncture VS Chinese medicine bath-foot + Ear Acupuncture(OR=-2.25,95%CI[-3.07,-1.14])、Ear Acupuncture VS Ear Acupuncture + Estazolam(OR=-1.80,95%CI[-3.20,-0.40]). Analysis showed that for the treatment of Hemodialysis patients with insomnia, the effectiveness of ear acupuncture surpassed estazolam and surazepam, of which this relationship also applied for: estazolam and surazepam,The efficacy of traditional Chinese medicine foot massage combined with auricular point therapy needs further verification.Conclusion:Auricular point therapy is simple and effective in treating insomnia of hemodialysis patients compared with various traditional Chinese and western medical therapies. Due to the limitation of the present studies,our findings also need further verification with larger-scale and well-designed RCTs.