针刺联合认知训练治疗脑卒中后认知障碍的系统评价

Systematic Evaluation of Acupuncture Combined with Cognitive Training for the Treatment of Post-stroke Cognitive Impairment

目的:系统评价针刺联合认知训练治疗脑卒中后认知障碍的疗效。方法:检索知网(CNKI)、维普(VIP)、万方数据库(WANFANG DATA)、中国生物医学文献数据库(CBM)、Pubmed、Web of Science、Co-chrane library等数据库自2015年10月至2022年5月关于脑卒中后认知障碍的针刺联合认知训练的随机对照试验(RCTs)。由2名评价者独立进行文献筛选、资料提取和纳入研究质量评价,采用RevMan5.4进行数据分析,计量资料计算均值差(MD)及其95%可信区间(CI)。结果:最终共纳入16项文献,共1278例受试者。结果显示,针刺联合认知康复训练在改善卒中后认知障碍患者的临床疗效[RR=1.26,95%CI(1.16,1.36),P<0.00001],蒙特利尔认知评定量表(MoCA)评分[MD=2.78,95%CI(1.52,4.04),P<0.0001],简易精神状态检查量表(MMSE)评分[MD=3.80,95%CI(1.84,5.76),P=0.0001],改良Barthel量表(MBI)评分[MD=10.17,95%CI(5.69,14.65),P<0.00001]方面优于对照组。通过GRADE评级来评估每个结局指标的证据质量,治疗有效率为中级,MMSE、MoCA和MBI为低级。结论:针刺联合认知训练与常规治疗相比,能显著改善卒中后认知障碍。

Objective:To systematically evaluate the efficacy of acupuncture combined with cognitive training in the treatment of post-stroke cognitive impairment.Methods:CNKI,VIP,WANFANG DATA,CBM,Pubmed,Web of Science Cochrane library,and other databases were searched for information on post-stroke cognitive impairment from October 2015 to May 2022;specifically,the search was to find the randomized controlled trials of acupuncture combined with cognitive training.The literature screening,data extraction,and research quality evaluation were conducted independently by two evaluators.The data were analyzed using RevMan5.4,and the mean difference(MD)and 95%confidence interval(CI)of the measurement data were calculated.Results:A total of 16 articles were included,comprising a total of 1278 subjects.The results showed that acupuncture combined with cognitive rehabilitation training could improve the clinical efficacy of patients with cognitive impairment after stroke[RR=1.26,95%CI(1.16,1.36),P<0.00001],Montreal Cognitive Assessment scale score[MD=2.78,95%CI(1.52,4.04),P<0.00001],Mini Mental State Examination score[MD=3.80,95%CI(1.84,5.76),P=0.0001],and modified Barthel Index score[MD=10.17,95%CI(5.69,14.65),P<0.00001]were superior to those for the control group.The evidence quality of each outcome index was evaluated by GRADE rating.The treatment efficiency and FMA were intermediate,and the MMSE,MoCA,and MBI were low.Conclusion:Compared with routine treatment,acupuncture combined with cognitive training can significantly improve post-stroke cognitive impairment.