不同针灸疗法联合三阶梯止痛法治疗癌痛的网状Meta分析

Different acupuncture therapy combined with three-step analgesic therapy in the treatment of cancer pain:a network Meta-analysis

[目的]对临床常用的针灸疗法(毫针刺法、耳穴疗法、电针、艾灸、穴位贴敷、穴位埋线、穴位注射)联合三阶梯止痛法治疗癌痛的有效性及安全性进行网状Meta分析,为探讨针药联合治疗方案提供科学的循证依据。[方法]通过计算机检索知网(CNKI)、维普(VIP)、万方(Wanfang)、中国生物医学文献(SinoMed)、PubMed、Cochrane Library、EMbase数据库、中国临床试验注册中心及美国临床试验注册中心的随机对照试验,时间限定为建库至2021年6月。由2名评价者分别进行独立筛选后,采用Stata14.0进行网状Meta分析。[结果]该项研究涉及63项随机对照试验,样本量共计5129例癌痛患者。数据结果表明,在临床有效率方面,所有针药联合疗法的有效性均优于单纯的三阶梯止痛法(P<0.05);在不良反应发生率方面,除“穴位埋线+三阶梯”组未纳入相关研究,其余针药联合疗法的安全性均优于单纯的三阶梯止痛法(P<0.05),穴位注射联合三阶梯止痛法的安全性明显优于电针联合三阶梯法(P<0.05)。SUCRA数值排序结果提示,穴位注射联合三阶梯止痛法的临床有效率最佳,不良反应发生率最低。[结论]所有针药联合疗法的有效性和安全性均优于单纯的三阶梯止痛法。在针药联合疗法中,穴位注射联合三阶梯止痛法的疗效最佳且安全性最高,可推荐作为治疗癌痛的首选方案。

[Objective]To systematically review the efficacy and safety of clinical acupuncture therapy(filiform needle,auricular acupoint therapy,electroacupuncture,moxibustion,acupoint application,acupoint catgut embedding,acupoint injection)combined with three-step analgesic therapy in the treatment of cancer pain by network Meta-analysis,so as to provide scientific evidence-based basis for the discussion of combined of acupuncture and drug therapy.[Methods]The RCTs were recruited in CNKI,VIP,Wanfang,Sinomed,PubMed,Cochrane Library,Embase databases,and Chinese Clinical Trial Registry,American Clinical Trial Registry.The time limit is to build the database until June 2021.There were two reviewers screening the data independently.And then the data analysis was performed by STATA 14.0.[Results]This study involved 63 randomized controlled trials with a total sample size of 5129 patients with cancer pain.The results showed that in terms of clinical effective rate,and the efficacy of all combined acupuncture and drug therapy was better than the simple three-step analgesic method(P<0.05).In terms of the incidence of adverse reactions,except for the“acupoint embedding+three-step analgesia”group,the safety of acupuncture and drug combined therapy was superior to the three-step analgesia alone(P<0.05),and the safety of acupoint injection combined with three-step analgesia was significantly superior to that of electroacupuncture combined with three-step analgesia(P<0.05).SUCRA numerical ranking results indicated that acupoint injection combined with three-step analgesic method had the best clinical effective rate and the lowest incidence of adverse reactions.[Conclusion]The efficacy and safety of all combined acupuncture and drug therapy were better than the simple three-step analgesic method.Among combined acupuncture and drug therapy,acupoint injection combined with three-step analgesia has the best efficacy and the highest safety,which can be recommended as the first choice for cancer pain.