穴位针刺干预心肺复苏的系统评价和Meta分析

Meta-analysis and Systematic Evaluation of Acupuncture in Cardiopulmonary Resuscitation

目的系统评价穴位针刺干预心肺复苏过程对提升复苏效果的有效性。方法通过检索中国知网(CNKI)、维普(VIP)、万方、中国生物文献库(CBM)、The Cochrane Library、PubMed、Embase、Web of Science等数据库,检索年限为数据库建库至2019年8月,检索所有在心肺复苏过程中施以穴位针刺的随机对照试验(RCTs)文献,利用Cochrane偏倚风险评估工具对纳入的文献质量进行风险评估,运用RevMan5.3软件对穴位针刺干预心肺复苏患者的自主循环恢复率(ROSC)、经复苏治疗后平均动脉压(MAP)、血氧饱和度(SpO2)以及复苏后生存率等指标进行Meta分析。结果共纳入了4个临床随机对照试验,共259例患者。Meta分析结果显示,穴位针刺干预心肺复苏并没有提高自主循环恢复率[OR=2.31,95%CI(0.68,7.83),P>0.05],没有提高存活率[OR=2.27,95%CI=(0.92,5.61),P>0.05],但是能提高复苏后平均动脉压水平[MD=7.12,95%CI=(2.16,12.07),P=0.005],提高血氧饱和度水平[MD=9.60,95%CI=(3.43,15.77),P=0.002]。结论穴位针刺干预心肺复苏并没有明显提高复苏疗效,但针刺干预对复苏的过程可能存在一定的促进作用。本次系统评价纳入文献的方法学以及质量均较低,样本量较少,因此仍然需要严谨的、大样本的随机双盲试验加以验证穴位针刺干预心肺复苏过程的临床疗效。

Objective:To systematically evaluate the effectiveness of acupoint acupuncture in improving the effect of cardiopulmonary resuscitation(CPR). Methods:RCTs of acupuncture in CPR were searched from science databases,such as CNKI,VIP,Wanfang data,CBM,PubMed,Embase,the Cochrane Library and Web. The quality of RCTs were evaluated by the Cochrane scale,and RevMan5.3 software was used to meta-analyze ROSC rate,MAP,SpO2 level and survival rate after resuscitation. Results:259 patients were included in 4 RCTs. Meta-analysis results showed that acupuncture in CPR did not improve ROSC rate[OR=2.31,95%CI(0.68,7.83),P > 0.05]and the survival rate[OR=2.27,95%CI=(0.92,5.61),P > 0.05],but increased MAP[MD=7.12,95%CI=(2.16,12.07)and SpO2 level[MD=9.60,95% CI=(3.43,15.77),P = 0.002]. Conclusion:The curative effect of acupuncture in CPR has no obvious increase,but acupuncture may play a certain role in promoting the process of resuscitation. All the research methods and reports included in this system are low quality,and the sample size is small.Therefore,the clinical efficacy of acupuncture in CPR still needs to be verified by rigorous,large-sample randomized double-blind trials.