针刺结合康复训练治疗脑卒中后平衡功能障碍的Meta分析

A Meta analysis of treating balance impairment after stroke by acupuncture plus rehabilitation training

目的:系统评价针刺结合康复训练治疗脑卒中后平衡功能障碍的有效性,为临床提供依据。方法:全面检索PubMed、Embase、Cochrane(Central)、Web of Science、中国知网(CNKI)、万方数据库(WF)、维普(VIP)及中国生物医学数据库(CBM)中相关研究,纳入分析针刺结合康复训练对比单纯康复训练治疗脑卒中后平衡功能障碍的随机对照试验。由两位评审员独立进行文献检索、研究筛选、数据提取及质量评估。本研究采用Cochrane风险评估工具以评估纳入研究的质量,并使用Review Manager 5.3和Stata 12.0进行统计分析。结果:共纳入随机对照研究15个,涉及总人数1122例。结果发现治疗结束后两组在Berg平衡功能评分、Fugl-Meyer平衡功能评分、Fugl-Meyer下肢运动功能评分、步行10 m时间及改良Barthel指数评分上的差异均有统计学意义,且针刺结合康复组疗效优于单纯康复组,WMD分别为5.63(95%CI:4.32~6.94,P<0.00001)、1.09(95%CI:0.58~1.60,P<0.00001)、2.71(95%CI:0.88~4.54,P=0.004)、-13.29(95%CI:-23.30^-3.28,P=0.009)、7.21(95%CI:2.27~12.15,P=0.004)。结论:针刺结合康复训练对比单纯康复训练在改善脑卒中后平衡功能障碍方面更有优势,差异有统计学意义。

Objective:This systematic review is to evaluate the effectiveness of acupuncture plus rehabilitation on balance impairment after stroke,and to provide a basis for clinical practice.Methods:PubMed,Embase,Cochrane(Central),Web of Science,CNKI,WF,VIP and CBM were extensively searched up to 2019 August.Study selection,data extraction and quality assessment were independently conducted by the two reviewers.The Cochrane Collaboration’s tool was used for assessing the risk of bias,and Review Manager 5.3 and Stata 12.0 were used for statistical analysis.Results:A total of 15 randomized controlled studies involving 1122 participants were included.There were significant differences in Berg’s balance function score,Fugl-Meyer’s balance function score,Fugl-Meyer’s lower limb motor function score,walking time of 10 meters and the modified Barthel index score between the two groups after treatment.WMD was 5.63(95%CI:4.32~6.94,P<0.00001),1.09(95%CI:0.58~1.60,P<0.00001),2.71(95%CI:0.88~4.54,P=0.004),-13.29(95%CI:-23.30^-3.28,P=0.009),7.21(95%CI:2.27~12.15,P=0.004)separately.Conclusion:Compared with the rehabilitation group,the acupuncture plus rehabilitation group showed more advantages in balance impairment after stroke.