针灸对中风后偏瘫患者疗效的Meta分析

A Meta-analysis of the efficacy of acupuncture and moxibustion on hemiplegia after stroke

目的:运用Meta分析评价针灸对中风后偏瘫患者的疗效,为临床提供循证依据。方法:在中国知网、万方数据知识服务平台、中文科技期刊全文数据库、中国生物医学文献数据库、PubMed和Cochrane Library 6个数据库中检索关于针灸对中风后偏瘫患者疗效的临床试验,时间范围为2017年10月―2022年10月。按纳入标准和排除标准进行文献筛选,根据Cochrane评价标准对纳入的文献进行方法学质量评价,应用RevMan 5.3软件进行Meta分析。结果:共纳入15篇文献,总病例数1476例。Meta分析结果显示针灸治疗中风后偏瘫患者总的临床疗效比常规康复治疗更显著[优势比(OR)=3.87,95%置信区间(CI)(2.55,5.90),I^(2)=0%,P<0.00001],肢体运动功能简式Fugl-Meyer评分法(Fugl-Meyer Assessment Scale,FMA)评分、日常生活活动能力(Acticities of Daily Living,ADL)评分和美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分均优于对照组[均数差(MD)=1.29,95%CI(0.93,1.65),I^(2)=89%,P<0.00001;MD=11.71,95%CI(6.72,16.70),P<0.00001,I^(2)=96%;MD=–4.96,95%CI(–7.75,–2.16),I^(2)=93%,P<0.00001]。对报道的FMA评分进行偏倚风险和敏感性分析,漏斗图图形无明显不对称性,提示存在发表偏倚可能性较小,敏感性分析结果表示异质性未见明显改变,表明研究结果较稳定。结论:针灸对中风后偏瘫患者的疗效优于常规康复治疗,能够显著改善中风后患者的偏瘫状况,促进运动能力、生活能力和神经功能的恢复。

Objective:To evaluate the efficacy of acupuncture and moxibustion on patients with hemiplegia after stroke by Meta-analysis system,and to provide evidence-based evidence for clinic.Methods:Clinical trials on the efficacy of acupuncture and moxibustion in treating patients with post-stroke hemiplegia were retrieved from six databases:China National Knowledge Network(CNKI),Wanfang Data,Chinese Science and Technology Journal Full Text Database(VIP),China Biomedical Literature Database(SinoMed),PubMed and Cochrane Library,with a time range from October 2017 to October 2022.Papers were screened according to the inclusion and exclusion criteria,methodological quality was evaluated according to Cochrane evaluation criteria,and Meta-analysis was performed using RevMan 5.3 software.Results:A total of 15 papers were included,with a total number of 1476 cases.The results of Meta-analysis showed that the overall clinical efficacy of acupuncture and moxibustion in the treatment of hemiplegia patients after stroke was more significant than that of the conventional rehabilitation treatment[OR=3.87,95%CI(2.55,5.90),I^(2)=0%,P<0.00001].Motor function score(FMA score),activity of daily living score(ADL score)and neurological function deficit score(NIHSS score)were better than those in the control group[MD=1.29,95%CI(0.93,1.65),I^(2)=89%,P<0.00001;MD=11.71,95%CI(6.72,16.70),I^(2)=96%,P<0.00001;MD=-4.96,95%CI(-7.75,-2.16),I^(2)=93%,P<0.00001].The reported FMA scores were analyzed for bias risk and sensitivity,and the funnel plot showed no obvious asymmetry,indicating a small possibility of publication bias.The sensitivity analysis showed no significant change in heterogeneity,indicating that the study results were stable.Conclusion:The efficacy of acupuncture and moxibustion on patients with hemiplegia after stroke is better than that of the conventional rehabilitation treatment,which can significantly improve the hemiplegia status of patients with stroke,and promote the recovery of movement ability,living ability and nerve function.