腹腔镜术后肩痛中医护理干预效果的网状meta分析

Mesh meta-analysis on the effect of traditional Chinese medicine nursing intervention on shoulder pain after laparoscopic surgery

目的采用网状meta分析评价中医护理对腹腔镜术后肩痛的干预效果。方法检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Web of Science,收集有关腹腔镜术后肩痛中医护理干预的随机对照试验(RCT),检索时限为建库至2022年5月。由2名研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用R软件进行网状meta分析。结果共纳入13个研究,术后24、48 h的肩痛视觉模拟评分法(VAS)评分的网状meta分析结果显示,常规护理联合中医护理缓解腹腔镜术后肩痛疗效均优于常规护理(P<0.05)。腹腔镜术后24 h镇痛效果排序前3位的依次为常规护理联合穴位按摩、常规护理联合耳穴压豆、常规护理联合艾灸,腹腔镜术后48 h镇痛效果排序前3位的依次为常规护理联合穴位贴敷、常规护理联合穴位按摩、常规护理联合穴位按摩/穴位敷贴。结论穴位按摩联合常规护理缓解腹腔镜术后24 h肩痛效果最佳,穴位敷贴联合常规护理缓解腹腔镜术后48 h肩痛效果最佳,但受文献数量和质量的影响,仍需更大样本的RCT进一步验证。

Objective To evaluate the intervention effect of traditional Chinese medicine(TCM)nursing on shoulder pain after laparoscopic surgery by mesh meta-analysis.Methods China National Knowledge Network,VIP,Wanfang,China Biomedical Literature Database,PubMed and Web of Science were searched to collect randomized controlled trials(RCT)on TCM nursing intervention after laparoscopic surgery for shoulder pain.The retrieval time was from the establishment of the database to May 2022.After literature screening,data extraction,and bias risk evaluation of included studies were independently conducted by two researchers,R software was used for mesh meta-analysis.Results A total of 13 studies were included,and the results of mesh meta-analysis of visual analogue scale(VAS)scores 24 h and 48 h after surgery showed that routine nursing combined with TCM nursing was superior to conventional nursing in alleviating shoulder pain after laparoscopic surgery(P<0.05).The top three analgesic effects of laparoscopic 24 h after surgery were routine nursing combined with acupoint massage,routine nursing combined with auricular point pressure bean>routine nursing+moxibustion.The top three analgesic effects of laparoscopic 48 h after surgery were routine nursing combined with acupoint application,routine nursing combined with acupoint massage,routine nursing combined with acupoint massage,acupoint application.Conclusion Acupoint massage combined with routine nursing has the best effect on alleviating shoulder pain 24 hours after laparoscopic surgery,and acupoint application combined with routine nursing has the best effect on alleviating shoulder pain 48 hours after laparoscopic surgery.However,due to the influence of the quantity and quality of literature,this conclusion still needs to be further verified by RCT with larger samples.