针灸治疗乳腺癌患者术后痛随机对照试验Meta分析

Acupuncture and Moxibustion for Postoperative Pain in Patients with Breast Cancer:A Meta-analysis of Randomized Controlled Trials

目的:系统评价针灸治疗乳腺癌术后痛的有效性及安全性。方法:检索PubMed、Embase、ClinicalKey、国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD),检索时限为建库至2021年1月。纳入针灸治疗乳腺癌术后痛的随机对照试验(RCT),采用RevMan 5.3软件进行质量评价及数据分析。结果:共纳入13项RCT(1 109例患者),Meta分析显示,针灸联合常规治疗对乳腺癌术后痛有效且优于常规治疗(SMD=-1.58,95%CI=-2.47~-0.68,P=0.000 6);电针治疗乳腺癌术后痛有效且优于药物治疗(SMD=-0.94,95%CI=-1.24~-0.64,P<0.000 01);温针灸+中药联合常规治疗(MD=-0.64,95%CI=-1.00~-0.27,P=0.000 7)、针刺联合常规治疗(SMD=-1.91,95%CI=-3.60~-0.21,P=0.03)和耳穴贴压联合常规治疗(MD=-1.24,95%CI=-2.24~-0.60,P=0.000 7)均有效且优于对照组。13项研究中无任何不良反应的报告。结论:针灸疗法多与其他疗法合用治疗乳腺癌术后痛,可一定程度减轻患者疼痛,提高患者生命质量,安全性好,但纳入研究设计存在缺陷,有待更多的高质量研究。

Objective:To systematically evaluate the efficacy and safety of acupuncture and moxibustion in treating postoperative pain of breast cancer.Methods:PubMed,Excerpta Medica Database(EMbase),ClinicalKey,China National Knowledge Infrastructure(CNKI),China Science Periodical Database(CSPD),and Chinese Citation Database(CCD)were searched from the inception to January 2021.The randomized controlled trials(RCTs)of acupuncture and moxibustion for postoperative pain of breast cancer were included in this study.RevMan 5.3 was used for quality evaluation and data analysis.Results:A total of 13 RCTs involving 1109 patients were included in this study.Meta-analysis showed that acupuncture and moxibustion combined with routine treatment was effective and better than conventional treatment for postoperative pain of breast cancer(SMD=-1.58,95%CI-2.47 to-0.68,P=0.0006).Electroacupuncture was effective and superior to drug treatment for postoperative pain of breast cancer(SMD=-0.94,95%CI-1.24 to-0.64,P<0.00001).Warm needle moxibustion and Chinese medicine combined with conventional treatment(MD=-0.64,95%CI-1.00 to-0.27,P=0.0007),acupuncture combined with conventional treatment(SMD=-1.91,95%CI-3.60 to-0.21,P=0.03),and auricular point sticking combined with conventional treatment(MD=-1.24,95%CI-2.24 to-0.60,P=0.0007)were effective and outperformed the control group.No adverse reactions were reported in 13 RCTs.Conclusion:Acupuncture and moxibustion are always combined with other therapies to reduce the pain and improve the quality of life of the patients,demonstrating high safety.However,there are shortages in the design of the included studies.The current clinical evidence cannot fully support the conclusion,and more high-quality studies are needed.