按摩对脑卒中后便秘患者疗效的Meta分析

Meta-analysis of the therapeutic effect of massage on patients with constipation after stroke

目的采用Meta分析评价按摩对脑卒中后便秘患者的综合疗效,为临床治疗提供参考。方法检索PubMed、Web Of Science、Cochrane、EBSCO、中国知网、万方数据和维普等数据库从建库起至2019年9月研究按摩对脑卒中后便秘患者综合疗效影响的随机对照试验,对符合纳入标准的随机对照试验,按照Cochrane协作网推荐的5.1.0版手册进行文献质量的逐一评估,并采用Cochrane协作网提供的软件RevMan 5.3进行分析。结果最终纳入15篇文献,共计1 224例患者。Meta分析结果显示,与常规治疗护理相比,按摩可以改善脑卒中后便秘患者治疗的总有效率[RR=1.41,95%CI(1.22,1.63),P<0.00001]。此外,一些次要指标的结果也优于对照组,包括改良Rankin量表[SMD=-0.53,95%CI(-1.02,-0.04),P=0.03]、抑郁自评量表[SMD=-1.25,95%CI(-1.73,-0.77),P<0.00001]、自拟量表1[RR=1.74,95%CI(1.26,2.40),P=0.0007]、自拟量表2[RR=1.17,95%CI(0.97,1.42),P=0.09]、自拟量表3[RR=1.92,95%CI(1.16,3.19),P=0.01]、自拟量表4[RR=1.22,95%CI(1.09,1.38),P=0.0008]、自拟量表5[RR=1.92,95%CI(1.11,3.30),P=0.02]。并且在"便秘症状及疗效评估问卷"量表的各因素上均有改进,包括排便困难[SMD=-1.75,95%CI(-2.38,-1.11)、P<0.00001]、粪便类型[SMD=-0.79,95%CI(-1.34,-0.23),P=0.006]、排便频率[SMD=2.50,95%CI(1.77,3.22),P<0.00001]、排便时间[SMD=-1.85,95%CI(-2.50,-1.21),P<0.00001]。结论按摩对脑卒中后便秘患者有确切的疗效。

Objective Meta-analysis is used to evaluate the comprehensive effect of massage on patients with constipation after stroke, so as to provide reference for clinical treatment.Methods The randomized controlled trials on the efficacy of massage in the treatment of constipation after stroke were retrieved in PubMed, Web of Science, Cochrane, EBSCO,China National Knowledge Internet(CNKI),Wan Fang Data, and Weipu Database until September 2019.These articles whose quality met the inclusion criteria were assessed one by one using the evaluation method which was conducted according to the manual(version 5.1.0) recommended by Cochrane Collaboration.The software RevMan 5.3 provided by the Cochrane Collaboration was used.Results A total of 15 studies with 1224 patients were included for the statistical analysis.Results showed that massage could improve the total effective rate of post-stroke constipation patients compared with conventional treatment(RR=1.41,95% CI(1.22,1.63),P<0.00001).Also, some secondary outcome indicators’ results were also superior to the control group, including the modified Rankin scale[SMD=-0.53,95% CI(-1.02,-0.04),P=0.03],the self-rating depression scale[SMD=-1.25,95% CI(-1.73,-0.77),P<0.00001],the self-designed scale 1[RR=1.74,95% CI(1.26,2.40),P=0.0007],the self-designed scale 2(RR=1.17,95% CI(0.97,1.42),P=0.09),the self-designed scale 3[RR=1.92,95% CI(1.16,3.19),P=0.01],the self-designed scale 4[RR=1.22,95% CI(1.09,1.38),P=0.0008],the self-designed scale 5[RR=1.92,95% CI(1.11,3.30),P=0.02].And the constipation symptoms and efficacy assessment questionnaire which was improved on all factors, including the difficulty in defecation[SMD=-1.75,95% CI(-2.38,-1.11),P<0.00001],the type of feces[SMD=-0.79,95% CI-1.34 to-0.23,P=0.006],the frequency of defecation[SMD=2.50,95% CI 1.77 to 3.22,P<0.00001],the defecation time[SMD=-1.85,95% CI(-2.50,-1.21),P<0.00001].Conclusions Massage therapy has a definite effect on patients with post-stroke constipation.