中医外治法治疗阿片类药物相关性便秘的网状Meta分析

A Network Meta Analysis of Traditional Chinese Medicine External Treatment for Opioid Drug Related Constipation

【目的】探讨网状Meta分析不同中医外治法治疗阿片类药物相关性便秘的疗效。【方法】计算机检索中国知网、万方、中国生物医学文献数据库、维普、PubMed、Embase、Web of Science和The Cochrane Library数据库中关于中医外治法治疗肿瘤患者阿片类药物相关性便秘的文献,检索时限均为建库至2023年3月20日。同时,追溯相关系统评价和纳入研究的参考文献。由两名研究者独立筛选文献和提取资料,评估文献质量。采用RevMan 5.3软件、Stata 17.0软件和R 4.2.3软件中的Gemtc程序包进行统计学分析。【结果】纳入17篇文献,共1570例患者,涉及7种干预措施。网状Meta分析结果显示,穴位贴敷+常规治疗(OR=7.00,95%CI=3.90~13.00,P<0.05)、艾灸+常规治疗(OR=6.20,95%CI=2.20~21.00,P<0.05)、腹部推拿+常规治疗(OR=8.80,95%CI=2.40~46.00,P<0.05)的疗效优于常规治疗,SUCRA值显示,疗效排名前三的中医外治法依次为腹部推拿+常规治疗(80.36%)、穴位贴敷+常规治疗(74.54%)、艾灸+常规治疗(68.76%)。【结论】推荐采用腹部推拿+常规治疗措施缓解阿片类药物相关性便秘,但在实际临床工作中,应考虑患者意愿、患者身体情况等多方面因素进行决策。

【Objective】To explore the efficacy of different traditional Chinese medicine external treatment methods in treating opioid related constipation through network meta-analysis.【Methods】Computer retrieval of literature on the treatment of opioid related constipation in cancer patients using traditional Chinese medicine external treatment methods in databases such as China National Knowledge Infrastructure,Wanfang,China Biomedical Literature Database,VIP,PubMed,Embase,Web of Science,and The Cochrane Library.The retrieval deadline is from the establishment of the database until March 20,2023.At the same time,trace the relevant system evaluations and include references in the research.Two researchers independently screened the literature and extracted data to evaluate the quality of the literature.Statistical analysis was conducted using the Gemtc package from RevMan 5.3 software,Stata 17.0 software,and R 4.2.3 software.【Results】A total of 1570 patients were included in 17 studies,involving 7 intervention measures.The results of the network meta-analysis showed that the efficacy of acupoint application+conventional treatment(OR=7.00,95%CI=3.90-13.00,P<0.05),moxibustion+conventional treatment(OR=6.20,95%CI=2.20-21.00,P<0.05),and abdominal massage+conventional treatment(OR=8.80,95%CI=2.40-46.00,P<0.05)was superior to conventional treatment.The SUCRA value showed that the top three traditional Chinese medicine external treatment methods in terms of efficacy were abdominal massage+conventional treatment(80.36%),acupoint application+conventional treatment(74.54%),and Moxibustion+conventional treatment(68.76%)respectively.【Conclusion】It is recommended to use abdominal massage combined with conventional treatment to alleviate opioid related constipation.However,in practical clinical work,multiple factors such as patient willingness and physical condition should be considered for decision-making.