多指标决策分析法优选电针治疗神经根型颈椎病方案研究

Study on optimized treatment program of cervical spondylotic radiculopathy with electroacupuncture by multi-index decision analysis method

目的:根据多指标决策分析法筛选电针治疗神经根型颈椎病(CSR)的优选方案。方法:检索中国知网、万方数据知识服务平台、维普中文期刊服务平台、中国生物医学文献服务系统(SinoMed)、PubMed和Cochrane Library数据库中电针治疗CSR的随机对照试验文献,选取改良Jadad评分≥2分的文献,使用多指标决策分析法优选电针治疗CSR的优选方案。纳入13项研究,以被纳入的每个试验组的电针疗法作为1个方案,根据各方案数据信息建立初始决策矩阵D,包括f1(改良Jadad评分)、f2(研究组样本量)、f3(治愈率)、f4(总有效率)、f5(治疗次数)5个指标;对5个指标通过极差变化法进行标准化处理构建标准化矩阵R,对标准化矩阵进行归一化处理,计算指标的熵值、差异度和指标权重,并构建加权标准化矩阵。采用理想解法求得13个治疗方案的贴近度,按相对贴近度进行排序,筛选出电针治疗CSR的最优选方案。结果:最优选方案为主穴选用天柱、颈百劳和大杼,配穴为曲池,穴位均取双侧。在天柱穴实施150~200次/min的快速捻转手法,不加电,每隔5 min行针1次;针刺颈百劳、大杼、曲池得气后与电针仪连接,密波+疏密波组合使用,先调节为10 min密波,后调节为20 min疏密波,以患者可耐受的电针强度为宜,1次/2 d,1个疗程治疗15次,共计1个疗程。结论:依据多指标决策分析法获得的电针治疗CSR的优选方案仍需临床进一步验证,未来需要更多关于颈三针治疗CSR的优质文献,为临床研究提供更多有力的证据支持。

Objective:To screen the optimized program of electroacupuncture for cervical spondylotic radiculopathy(CSR)according to multi-index decision analysis method.Methods:CNKI,Wanfang Data Knowledge Service Platform,VIP China Journal Service Platform,SinoMed,PubMed and Cochrane Library were searched for randomized controlled trials of electroacupuncture in the treatment of CSR,and the articles with modified Jadad score≥2 were selected.The multi-index decision analysis method was used to optimize the treatment of electroacupuncture for CSR.13 studies were included,and electroacupuncture therapy in each of the included experimental groups was taken as a program.An initial decision matrix D was established according to the data information of each program,including 5 indicators:f1(modified Jadad score),f2(sample size of the study group),f3(cure rate),f4(total effective rate)and f5(treatment times).The five indicators were standardized by the range variation method to construct a standardized matrix R,and the standardized matrix was normalized.The entropy value,difference degree and weight of the index were calculated,and the weighted standardized matrix was constructed.The closeness degree of 13 treatment schemes was obtained by the technique of order preference by similarity to ideal solution according to the relative closeness degree to screen out the most optimal program of electroacupuncture for CSR.Results:The most optimal program was to choose Tianzhu,Jingbailao and Dazhu as the main acupoints,and the matching acupoints were Quchi.The acupoints were taken on both sides.Rapid twisting technique of 150-200 times/min was applied at Tianzhu acupoint without electricity,which was taken once every 5 minutes.After bringing about the desired sensation in the acupuncture of the Jingbailao,Dazhu and Quchi acupionts,they were connected with the electroacupuncture instrument,and the combination of condensation wave and dilatational wave was used.The intensity of electroacupuncture instrument was adjusted to 10 min condensation wave first and then to 20 min dilatational wave,which was suitable for the patient′s tolerance.The treatment was given once every 2 days,15 times in one course,and a total course of treatment was given.Conclusion:The optimal program of electroacupuncture for CSR based on multi-index decision analysis method still needs to be further verified in clinical practice.In the future,more high-quality literature on the treatment of CSR with cervical three acupoints acupuncture is needed to provide more powerful evidence for clinical research.