火针治疗周围性面瘫疗效及安全性的Meta分析

Meta-analysis of Therapeutic Efficacy and Safety of Fire Needling for Treatment of Peripheral Facial Paralysis

【目的】系统评价火针治疗周围性面瘫的疗效与安全性,为临床决策提供循证依据。【方法】通过计算机检索中国知网期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据知识服务平台(Wanfang)、SinoMed、美国医学在线(PubMed)、国际循证医学图书馆(Cochrane Library)、Embase等数据库,查找火针治疗周围性面瘫的随机对照试验文献。检索时间从数据库建库至2020年3月。运用Cochrane偏倚风险评估工具对纳入的文献进行偏倚风险分析,采用Review Manager 5.3软件对纳入研究的总有效率、治愈率、改良Portmann评分、周围性面瘫症状积分及不良反应进行Meta分析。【结果】Meta分析结果显示,火针联合疗法治疗周围性面瘫在提高总有效率[RR=1.19,95%CI(1.13,1.25),Z=6.74,P<0.00001]、治愈率[RR=1.45,95%CI(1.23,1.71),Z=4.35,P<0.0001]、改良Portmann评分[MD=4.40,95%CI(2.70,6.11),Z=5.06,P<0.00001]、降低周围性面瘫症状积分[MD=-4.09,95%CI(-4.27,-3.91),Z=44.91,P<0.00001]方面优于单一疗法;安全性评价提示火针联合疗法无明显不良反应。【结论】火针联合疗法治疗周围性面瘫疗效较好且相对安全,但鉴于纳入研究样本量少,研究质量较低,尚需开展更多大样本、多中心、高质量的临床研究进一步验证。

Objective To systematically evaluate the therapeutic efficacy and safety of fire needling for treatment of peripheral facial paralysis and to provide evidence-based basis for clinical decision-making.Methods The CNKI,VIP,Wanfang,SinoMed,PubMed,Cochrane Library,Embase databases were searched for the clinical randomized controlled trials on fire needling for treating peripheral facial paralysis.The retrieval time was from database establishment to March,2020.Cochrane tool was used for bias risk assessment of included literatures.The total effective rate,cure rate,modified Portmann score,symptom score of peripheral facial paralysis and adverse reactions were analyzed by Review Manager 5.3 software.Results The results of Meta-analysis showed that fire needling combination therapy for peripheral facial paralysis was superior to single therapy in improving the overall effective rate[RR=1.19,95%CI(1.13,1.25),Z=6.74,P<0.00001],cure rate[RR=1.45,95%CI(1.23,1.71),Z=4.35,P<0.0001]and modified Portmann score[MD=4.40,95%CI(2.70,6.11),Z=5.06,P<0.00001]and in reducing the symptom score of peripheral facial paralysis[MD=-4.09,95%CI(-4.27,-3.91),Z=44.91,P<0.00001].The safety evaluation indicated that fire needling combination therapy had no obvious adverse reactions.Conclusion Fire Needling combination therapy is of better therapeutic efficacy and relative safe for peripheral facial paralysis.However,in view of the small sample size and low-quality of the included studies,more large-scale,multi-center,high-quality clinical researches still need to be further verified.