针药结合干预脑卒中后抑郁的网状Meta分析

Reticular meta-analysis of acupuncture combined with medication intervention for post-stroke depression

目的:系统评价针药结合治疗卒中后抑郁(PSD)的治疗效果。方法:计算机检索中国知网(CNKI)、万方数据知识服务平台、维普中文期刊数据库(VIP)、Pubmed、Embase中针药结合治疗卒中后抑郁(PSD)的随机对照试验(RCT)文献,检索时间为建库至2023年7月29日,采用RevMan 5.3、ADDIS 1.16.8软件进行传统Meta分析以及网状Meta分析。结果:最终纳入49篇文献,共3817例患者,涉及针刺、中药、灸法、电针、针刺+中药、针刺+西药、灸法+中药、灸法+西药、电针+中药、电针+西药、西药11种疗法。结果显示:①有效率:电针+中药疗效最好,排名前3的治疗方法依次为电针+中药、灸法+西药、针刺+西药;②汉密尔顿抑郁量表(HAMD)评分:灸法+中药疗效最好,排名前3的治疗方法依次为灸法+中药、电针+中药、针刺+西药;③美国国立卫生研究院卒中量表(NIHSS)评分:灸法+西药疗效最好,排名前3的治疗方法依次为灸法+西药、电针+西药、针刺+中药。结论:在有效率与卒中后抑郁症状缓解方面针药结合疗法优于单用西药、中药以及针灸疗法,且综合三项指标来看,电针+中药疗法疗效最佳。

Objective:To systematically evaluate the therapeutic effect of acupuncture combined with medicine on poststroke depression(PSD).Methods:The randomized controlled trial(RCT)literature of acupuncture combined with medication in the treatment of PSD in CNKI,Wanfang Data Knowledge Service Platform,VIP Chinese Journal Database,Pubmed and Embase was searched by computer from the database establishment to July 29,2023.Traditional meta-analysis and reticular meta-analysis were performed by using RevMan 5.3 and ADDIS 1.16.8 software.Results:Finally,49 articles were included,with a total of 3817 patients,involving 11 kinds of therapies including acupuncture,Chinese herbs,moxibustion,electroacupuncture,acupuncture+Chinese herbs,acupuncture+western medicine,moxibustion+Chinese herbs,moxibustion+western medicine,electroacupuncture+Chinese herbs,electroacupuncture+western medicine,and western medicine.The results showed that:①Effective rate:electroacupuncture+Chinese herbs had the best effect,and the top 3 treatment methods were electroacupuncture+Chinese herbs,moxibustion+western medicine,and acupuncture+western medicine;②Hamilton Depression Scale(HAMD)score:moxibustion+Chinese herbs had the best effect,and the top 3 treatment methods were moxibustion+Chinese herbs,electroacupuncture+Chinese herbs,and acupuncture+western medicine;③National Institutes of Health Stroke Scale(NIHSS)score:moxibustion+western medicine had the best effect,and the top 3 treatment methods were moxibustion+western medicine,electroacupuncture+western medicine,and acupuncture+Chinese herbs.Conclusion:In terms of effective rate and PSD relief,the combined therapy of acupuncture and medication is superior to the single use of western medicine,Chinese herbs or acupuncture and moxibustion,and from the perspective of three indicators,the combined therapy of electroacupuncture and Chinese herbs has the best effect.