针灸治疗对脑卒中患者康复效果的Meta分析

Meta-analysis of the effect of acupuncture on rehabilitation of stroke patients

目的系统评价针灸治疗对脑卒中患者康复的有效性。方法检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库、PubMed、Cochrane Library等数据库,检索日期自建库至2018年12月。采用Cochrane协作网偏倚风险工具进行风险评估,采用Jadad评分进行质量评价,采用Review Manager 5.3.5统计软件对Jadad评分≥3分的文献进行Meta分析,通过Begg’s检验分析发表偏倚。结果共纳入40篇文献,对其中Jadad评分≥3分的18篇文献进行Meta分析。结果显示,与对照组比较,试验组可有效提高患者的总有效率(P<0.05),且可明显降低患者的神经功能缺损(NIHSS)评分,增加Barthel指数(BI)(P<0.05)。结论单纯针灸或联合药物及其他疗法治疗对脑卒中患者康复的效果明显优于单纯药物及其他疗法,今后仍需通过更加严格、高质量的临床随机对照研究进一步验证。

Objective To make a systematic evaluation of the effectiveness of acupuncture therapy on the rehabilitation of stroke patients.Methods We searched China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBM),Wanfang Data Knowledge Service Platform,VIP,PubMed,Cochrane Library and other databases,with the retrieval date from the establishment of the database to December 2018.The Cochrane Collaboration’s tool for assessing risk of bias was used to assess the risk of the included studies.Jadad score was used to evaluate the quality thereof.The Review Manager 5.3.5 software was used for meta-analysis of the studies with Jadad score≥3.Publication bias was analyzed by Begg’s test.Results Forty documents were included.Among them,18 documents with Jadad score≥3 were analyzed by meta-analysis.The results of meta-analysis showed that,compared with the control group,the experimental group could effectively improve the total effective rate of the patients(P<0.05),significantly decrease National Institute of Health stroke scale(NIHSS)score,and increase Barthel index(BI)(P<0.05).Conclusion The therapeutic effect of acupuncture alone or combined with medicines and other therapies on the rehabilitation of stroke patients is markedly better than that of medicines alone and other therapies.However,more strict and high-quality clinical multicenter randomized controlled trials are still needed for further verification in the future.