针灸治疗中风后肩手综合征的优势方案筛选研究

Optimized Treatment Plan of Acupuncture in Treating Post-Stroke SHS

目的:基于针灸治疗中风后肩手综合征的高质量临床证据与多指标决策分析法,获得针灸治疗该病的最优干预方案。方法:全面检索国内外医学文献数据库,根据循证医学Jadad评分筛选出高质量临床证据,采用多指标决策分析法,构建标准化矩阵和加权标准化矩阵,计算各方案与理想解的相对贴近度,筛选出针灸治疗中风后肩手综合征的最优方案。结果:共纳入13项高质量RCT,筛选出针灸治疗中风后肩手综合征的最优方案为以调神止痛针法针刺耳穴神门、水沟、内关、患侧肩髃、肩贞、肩髎和阳陵泉,1次/d,共治疗24次。结论:现有的高质量临床证据和多指标决策分析法结果说明了针刺的疗效可能与整体和局部共同调节作用有关,治疗时选穴应以促进中风后神经功能恢复的头部穴位和改善肢体功能的局部穴位为主,兼顾整体调神止痛与局部疏通经络。

Objective:To obtain the optimal intervention method of acupuncture for the treatment of post-stroke shoulder-hand syndrome(SHS)based on high quality clinical evidence and multi-index decision analysis.Methods:The medical literature databases were comprehensively searched based on evidence-based medicine and the Jadad score was used to screen out high quality clinical evidence,the multi-index decision analysis method was used to construct the standardized matrix and weighted standardized matrix to calculate the relative closeness between each scheme and the ideal solution and screen out the optimal scheme of acupuncture treatment for post-stroke SHS.Results:A total of 13 high quality RCTs were included,the optimized scheme of acupuncture for post-stroke SHS was needling ear point of Shenmen(MA-TF1),Shuigou(DU26),Neiguan(PC6),and needling Jianyu(LI15),Jianliao(TE14),Jianzhen(SI9)and Yanglingquan(GB34)on the affected side with Tiaoshen Zhitong(mental regulating and pain relieving)acupuncture.The treatment was once a day for 24 days.Conclusion:The existing high-quality clinical evidence and the results of multi-index decision analysis indicate that the curative effect of acupuncture may be related to the common regulating the whole and the local.During the treatment,the selected acupoints should be mainly the scalp acupoints that promote the recovery of neurological function after stroke and the local acupoints that improve the function of limbs,as well as the overall mental adjustment and analgesia and the local activation of channels and collaterals.