针刺联合三阶梯止痛法治疗癌痛疗效与安全性的Meta分析

A Meta-analysis of the Efficacy and Safety of Acupuncture Combined with Three-step Analgesic Ladder on Cancer Pain

目的系统评价针刺联合三阶梯止痛法治疗癌痛的疗效和安全性。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CMB)、重庆维普数据库(VIP)、万方数据知识服务平台(Wan Fang Data)、PubMed、The Cochrane library、Embase数据库自1986年1月至2019年10月,查找针刺联合三阶梯止痛法治疗癌痛的随机对照试验,由2名研究者独立进行数据提取和质量评价交叉核对后采用RevMan5.3软件进行Meta分析。结果共纳入14个随机对照研究,纳入患者合计1 072人。Meta分析结果显示:与单纯应用三阶梯止痛法相比,针刺联合三阶梯止痛法能够提高癌痛治疗的总有效率[RR=1.22,95%CI(1.15,1.28),P<0.0001],减轻患者疼痛(降低NRS评分)[RR=-0.68,95%CI(-0.92,-0.45),P<0.0001],改善患者的生存质量(升高KPS评分)[RR=4.82,95%CI(1.73,7.91),P=0.02],减少恶心[RR=0.49,95%CI(0.35,0.68),P<0.0001],呕吐[RR=0.60,95%CI(0.38,0.93),P=0.02],便秘[RR=0.48,95%CI(0.35,0.65),P<0.0001]消化道不良反应的发生,差异均具有统计学意义(P<0.05)。结论针刺联合三阶梯止痛法能够显著提高治疗癌痛的总有效率,减轻患者疼痛,改善患者生存质量,减少癌痛患者恶心、呕吐、便秘消化道不良反应的发生,由于纳入研究的样本量总体较少,质量评价比较低,该结论还需要大样本、高质量的随机对照研究进一步证实。

Objective:To systematically evaluate the efficacy and safety of acupuncture combined with three-step analgesia ladder on cancer pain. Methods:CNKI,CMB,VIP,Wan Fang Data,PubMed,and The Cochrane library database were searched from January 1986 to October 2019 for randomized controlled trials of acupuncture combined with three-step analgesia ladder on cancer pain. Data extraction and quality evaluation were crosschecked independently by two researchers,and meta-analysis was conducted with RevMan5.3 software. Results:14 randomized controlled studies were included,including 1 072 patients. Meta-analysis results showed that compared with the simple three-step analgesic ladder,the acupuncture combined with it can improve the total effective rate of treatment pain[RR=1.22,95%CI(1.15,1.28),P<0.0001],relieve patients pain(lowering NRS score)[RR=-0.68,95%CI(-0.92,-0.45),P<0.0001],improve the quality of life in patients(elevating KPS score)RR=4.82,95%CI(1.73,7.91),P=0.02). Nausea[RR=0.54,95%CI(0.39,0.75),P=0.0003],vomiting[RR=0.60,95%CI(0.38,0.93),P=0.02],and constipation[RR=0.48,95%CI(0.35,0.65),P<0.0001]were all statistically significant. Conclusion:Acupuncture combined three-step analgesic ladder significantly improve the total effective rate of treatment of cancer pain,reduce the pain of patients,improve the quality of life,and reduce the occurrence of nausea,vomiting and constipation. Due to the small sample size and low quality evaluation,the conclusion needs to be further confirmed by large sample and high-quality randomized control study.