穴位按摩治疗脑卒中后吞咽障碍效果的Meta分析

Effectiveness of acupoint massage on post-stroke dysphagia:a Meta-analysis

[目的]系统评价穴位按摩治疗脑卒中后吞咽障碍的疗效,为临床治疗和进一步研究提供参考依据。[方法]计算机检索Cochrane Library、PubMed、EMbase、CINAHL、中国知网、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据库中有关穴位按摩治疗脑卒中后吞咽障碍临床疗效的随机对照试验文献,同时筛检纳入文献的参考文献,检索时限为建库至2018年3月15日。由2名研究员按照纳入和排除标准筛选文献、评价质量、提取资料和合并数据,采用RevMan 5.3软件对文献进行Meta分析。[结果]共纳入10篇随机对照试验,涉及930例病人。Meta分析结果表明,穴位按摩组吞咽功能改善效果优于单一康复治疗组,差异具有统计学意义[SMD=1.58,95%CI(1.37,1.78),P<0.00001;RR=1.36,95%CI(1.26,1.47),P<0.00001];与单一康复治疗组比较,穴位按摩降低病人吸入性肺炎发生率效果不明显[RR=0.40,95%CI(0.16,0.99),P=0.05]。[结论]现有证据表明,穴位按摩能够促进脑卒中后吞咽障碍病人吞咽功能的恢复,但是尚没有足够证据说明其能够降低吸入性肺炎的发生率。

Objective:To systematically evaluate the effectiveness of acupoint massage on post‐stroke dysphagia,and to provide reference for clinical treatment and further study.Methods:Randomized controlled trials,which were related to clinical efficacy of acupoint massage on post‐stroke dysphagia,were searched in Cochrane Library,PubMed,EMbase,CINAHL,CNKI,CBM,Weipu Database,and Wanfang database by computer,and reference in the literatures were screened.The retrieval time was from inception to March 15,2018.According to the predefined inclusion and exclusion criteria,literature quality evaluation,data extraction and combination was evaluated by two researchers.And then Meta‐analyses were performed by using RevMan 5.3 software.Results:A total of 10 randomized controlled trials were included,involving 930 patients.Meta analyses showed that,the improvement of swallowing function on acupoint massage group was superior to the single rehabilitation group.The difference was statistically significant[SMD=1.58,95%CI(1.37,1.78),P<0.00001;RR=1.36,95%CI(1.26,1.47),P<0.00001];Compared with single rehabilitation group,the effect of acupoint massage in reducing the incidence of aspiration pneumonia was not statistically significant[RR=0.40,95%CI(0.16,0.99),P=0.05].Conclusion:According to the current literatures,acupoint massage could improve swallowing function in patients with post‐stroke dysphagia.But there was not enough evidence to testify that it could decrease the incidence of aspiration pneumonia.