耳穴贴压改善围绝经期女性失眠的系统综述

A systematic review on the improvement of insomnia in perimenopausal women with auricular acupoint pressing

目的系统评价耳穴贴压改善围绝经期女性失眠的效果。方法计算机检索国内外数据库中耳穴贴压改善围绝经期失眠的随机对照试验,检索时间为各数据库建库至2018年10月25日。由2名研究者独立筛选文献、提取资料并评价纳入文献的偏倚风险,利用RevMan 5.3分析软件进行数据分析。结果共纳入6篇中文文献。Meta分析结果显示,耳穴贴压与艾司唑仑相比,对降低匹兹堡睡眠质量指数(PSQI)得分差异无统计学意义(WMD=-0.06,95%CI:-0.96~0.84,P=0.90);耳穴贴压在降低PSQI得分方面优于安神补心胶囊(WMD=-5.16,95%CI:-7.37^-2.95,P<0.00001);耳穴贴压能有效改善围绝经期失眠,差异有统计学意义(RR=1.19,95%CI:1.08~1.31,P=0.0004);耳穴贴压联合口服加味黄连阿胶汤在降低阿森斯失眠量表(AIS)得分方面优于仅口服加味黄连阿胶汤(WMD=-2.60,95%CI:-4.42^-0.78,P=0.005);耳穴贴压联合柴胡桂枝龙骨牡蛎汤加减治疗与柴胡桂枝龙骨牡蛎汤加减治疗相比,可有效降低改良Kupperman评分(WMD=-4.07,95%CI:-6.36^-1.78,P=0.0005)。在睡眠状况自评量表得分方面,耳穴贴压与艾司唑仑相比,差异无统计学意义(WMD=-0.16,95%CI:-1.26~0.94,P=0.78)。结论耳穴贴压在提高总有效率,降低PSQI得分、AIS得分和改良Kupperman评分等方面具有优势。受纳入文献数量和质量的限制,尚需更多远期随访的大样本高质量研究加以验证。

Objective To systematically evaluate effects of auricular acupoint pressing on improving perimenopausal insomnia.Methods The randomized controlled trials of auricular plaster therapy to improve perimenopausal insomnia was searched by computer in domestic and foreign databases,and the search time was from the establishment of each database to October 25,2018.Two researchers independently screened the literature,extracted data and evaluated the risk of bias in the included literature and RevMan 5.3 analysis software was used for data analysis.Results A total of 6 Chinese literatures were included.Meta-analysis results showed that there was no statistically significant difference in Pittsburgh Sleep Quality Index(PSQI)score reduction by auricular acupoint pressing compared with estazolam(WMD=-0.06,95%CI:-0.96-0.84,P=0.90).Auricular acupoint pressing was better than Anshen Buxin capsule in reducing PSQI score(WMD=-5.16,95%CI:-7.37--2.95,P<0.00001).Auricular acupoint pressing could effectively improve perimenopausal insomnia,and the difference was statistically significant(RR=1.19,95%CI:1.08-1.31,P=0.0004).Auricular acupoint pressing with beans combined with oral modified Huanglian Ejiao Decoction was better than oral modified Huanglian Ejiao Decoction alone in reducing Athens Insomnia Scale(AIS)scores(WMD=-2.60,95%CI:-4.42--0.78,P=0.005).Compared with modified Chaihu Guizhi Longgu Muli Decoction treatment,auricular acupoint pressing combined with modified Chaihu Guizhi Longgu Muli Decoction could effectively reduce the modified Kupperman score(WMD=-4.07,95%CI:-6.36--1.78,P=0.0005).In terms of reducing the scores of the social support scale,there was no statistically significant difference between the auricular acupoint pressing with beans and estazolam(WMD=-0.16,95%CI:-1.26-0.94,P=0.78).Conclusions Auricular acupoint pressing has advantages in improving the total effective rate,reducing PSQI score and AIS score and improving Kupperman score.Limited by the quantity and quality of the included literatures,more large-sample high-quality studies with long-term follow-ups are needed for verification.