不同针刺疗法对比康复疗法治疗中风后肩手综合征:网状Meta分析

A network Meta-analysis of different acupuncture therapy versus rehabilitation therapy on shoulder and hand syndrome after stroke

目的:采用网状Meta分析的方式系统评价不同针刺疗法与针刺疗法与康复治疗的联合疗法治疗中风后肩手综合征的有效性。方法:计算机检索CNKI、SinoMed、万方、维普、The Cochrane Library、PubMed、EMbase数据库,搜集与不同针刺疗法、康复治疗及二者的联合疗法治疗中风后肩手综合征相关的临床随机对照试验(Randomized Controlled Trial,RCT),检索时间均为建库至2020年11月15日。由2名研究人员独立对相关文献进行筛选,数据提取、纳入和文献质量评价,并将所得数据通过Stata 16.0与R 3.6.1软件进行数据运算分析与绘图。结果:共纳入30个RCT研究,总计2502名患者,涉及不同针刺疗法及针刺与康复治疗的联合疗法共8种。网状Meta分析结果显示:共产生11个直接比较、28个间接比较,其中差异具有统计学意义的比较数为19个。结论:①所有单纯针刺疗法及不同针刺联合康复治疗的疗效均优于单纯运用康复治疗;②在不同针刺疗法与康复治疗的联合疗法中,温针灸与康复治疗的联合疗法疗效最优。但是由于所纳入文献可能存在不同程度的不足,本研究的结论仍需更多设计谨慎严格、方法科学的RCT予以验证。

Objective:To systematically evaluate the effectiveness of different acupuncture therapy and acupunture therapy plus rehabilitation therapy in the treatment of shoulder and hand syndrome after stroke by the method of network meta-analysis.Methods:In CNKI,SinoMed,Wanfang,VIP,The Cochrane Library,PubMed and EMbase databases,clinical randomized controlled trials related to different acupuncture therapy,and rehabilitation therapy plus acupuncture therapy on post-stroke shoulder and hand syndrome were retrieved.The retrieval time was from the database construction to November 15,2020.Related literature was screened,extracted,included and evaluated independently by two researchers.The obtained data was analyzed and mapped by Stata 16.0 and R 3.6.1 software.Results:A total of 30 RCTS with a total of 2502 patients were included,involving in 8 different acupuncture treatments and acupuncture plus rehabilitation treatments.The results of network Meta-analysis showed that there were 11 direct comparisons and 28 indirect comparisons,among which 19 were statistically significant.Conclusion:①All simple acupuncture treatments and different acupuncture plus rehabilitation treatments are more effective than rehabilitation alone;②In different acupuncture methods plus rehabilitation treatments,warming needle moxibustion plus rehabilitation has the best effect.However,because of varying degrees defects of the included literature,the results of this study should be checked with more carefully and scientifically designed RCTs.