推拿治疗功能性便秘有效性和安全性的系统评价和Meta分析

Systematic review and Meta analysis on the effectiveness and safety of tuina in treatment of functional constipation

目的:系统评价推拿治疗功能性便秘的有效性和安全性。方法:计算机检索中国生物医学文献数据库(SinoMed)、中国期刊全文数据库(CNKI)、万方学术期刊全文数据库(Wanfang)、维普中文科技期刊数据库(VIP)、PubMed、荷兰医学文献数据库(EMbase)、Cochrane图书馆(Cochrane Library)7个数据库自建库至2020年3月28日收录的推拿治疗功能性便秘的文献,对纳入文献进行资料提取和质量评价后,使用RevMan5.3软件进行Meta分析。结果:共纳入16篇文献,病例数1424例。Meta分析结果提示:①治疗组的总有效率高于对照组(RR=1.28,95%CI:1.16~1.42,P<0.00001);②治疗组对功能性便秘的中医病证诊断疗效标准有效率高于对照组(RR=1.38,95%CI:1.25~1.52,Z=6.31,P<0.00001);③治疗组治疗功能性便秘的不良反应低于对照组(RR=0.10,95%CI:0.02~0.49,Z=2.81,P=0.005);④辨证施用推拿手法治疗功能性便秘的有效率高于对照组(RR=1.50,95%CI:1.08~2.10,Z=2.39,P=0.02);⑤治疗组改善功能性便秘患者粪便性状、排便时间、排便频率优于对照组(P<0.05)。结论:推拿治疗功能性便秘具有一定的疗效优势,且不良反应少,可以改善功能性便秘的相关症状,但尚需更多高质量、大样本的随机对照试验进一步验证其疗效。

Objective To review systematically the effectiveness and safety of tuina(Chinese massage)in treatment of functional constipation.Methods The articles on functional constipation treated with tuina were collected by computer retrieval from 7 databases from the date of establishment to March 28,2020,including Chinese biomedical literature database(SinoMed),China journal full-text database(CNKI),full-text database of Wanfang academic journals(Wanfang),VIP Chinese science and technology journal database(VIP),PubMed,Dutch medical literature database(EMbase)and the Cochrane Library.After data extraction and quality evaluation of the included articles,Meta analysis was conducted with RevMan5.3 software.Results A total of 16 articles were included,with 1424 cases involved.Meta analysis results showed:①The total effective rate in the treatment group was higher than that in the control group(RR=1.28,95%CI:1.16-1.42,P<0.00001).②The effective rate for the symptoms of functional constipation in traditional Chinese medicine in the treatment group was higher than that in the control group(RR=1.38,95%CI:1.25-1.52,Z=6.31,P<0.00001).③Adverse reactions in the treatment group in the treatment of functional constipation were less than those in the control group(RR=0.10,95%CI:0.02-0.49,Z=2.81,P=0.005).④The effective rate of functional constipation treated on the base of syndrome differentiation in the treatment group was higher than that of the control group(RR=1.50,95%CI:1.08-2.10,Z=2.39,P=0.02).⑤The improvements in fecal characteristics,defecation time and defecation frequency of the patients with functional constipation in the treatment group were better than those in the control group(P<0.05).Conclusion Tuina therapy presents a certain advantages on its curative effect on functional constipation,has less adverse reactions and relieves the relevant symptoms of functional constipation.But more randomized controlled trials with high quality and large sample are required to provide further verification of its effect.