针灸在卒中后失语康复过程中有效性的网状Meta分析

Efficacy of Acupuncture and Moxibustion for Aphasia after Stroke:A Network Meta-analysis

目的系统评价针灸治疗卒中后失语的临床疗效。方法计算机检索PubMed,Medline,Cochrane Library,中国知网(CNKI),维普VIP,CBM,万方数据库等数据库,检索发表的针灸治疗卒中后失语的随机对照试验(RCT)文献,检索时间为从建库至2019年10月,并由2名研究者对每项纳入的研究进行质量和偏倚风险评估。应用stata14.0和GeMTC 0.14.3进行数据统计与构图。结果15个研究被纳入,包括1201例病人。共包括靳三针+康复、舌针+康复、头电针+康复、刺血+康复、针刺+中药、针刺+药加康复、针灸综合疗法+康复、舌针+头针+康复、头针+心理干预+康复和康复(语言康复训练)等10种疗法。其中头电针+康复和针灸综合疗法+康复与单一语言康复疗法相比具有统计学意义。按疗效从高往下排序,依次为头电针+康复>针灸综合疗法+康复>康复。结论从本网状Meta分析的结果来看,针灸联合其他疗法治疗卒中后失语,疗效明显优于单一语言康复疗法。头电针+康复为卒中后失语的最佳治疗方法的可能想较大,未来仍需高质量的临床研究验证。

Objective To evaluate the clinical efficacy of acupuncture and moxibustion in the treatment of aphasia after stroke.Methods We searched Pubmed,Medline,Cochrane Library,CNKI,VIP,CBM and Wanfang from inception to October 2018,to collect RCTs for treatment of aphasia after stroke.According to Cochrane Handbook,two researchers assessed the risk of quality and bias independently.GeMTC 0.14.3 and stata 14.0 were used to do statistics and network structure diagram.Results A total 15 studied met the inclusion criteria,1211 cases included,involving JIN's three needles+rehabilitation,tongue needle+rehabilitation,scalp electro-acupuncture+rehabilitation,pricking blood+rehabilitation,acupuncture+traditional Chinese medicine,acupuncture+Chinese medicine+rehabilitation,combined therapy with acupuncture+rehabilitation,tongue needle+scalp needle+rehabilitation,scalp acupuncture+psychological intervention+rehabilitation and rehabilitation(language rehabilitation training).Compared with single language rehabilitation training,scalp electro-acupuncture+rehabilitation and combined therapy with acupuncture+rehabilitation had statistical significance.According to the curative effect,they were ranked from high to low as following:scalp electro-acupuncture+rehabilitation>combined therapy with acupuncture+rehabilitation>rehabilitation.Conclusion According to the results of this network Meta-analysis,the effect of acupuncture combined with other therapies on post-stroke aphasia is better than rehabilitation therapy.Scalp electro-acupuncture+rehabilitation may be the best treatment for aphasia after stroke,and high-quality clinical research is still needed in the future.