中药联合针灸治疗脑卒中后吞咽障碍疗效的Meta分析

Efficacy of Traditional Chinese Medicine Combined with Acupuncture for Treating Post-Stroke Dysphagia:A Meta-analysis

目的 系统评价中药联合针灸治疗脑卒中后吞咽障碍的有效性。方法 检索PubMed、Embase、Cochrane Library、Web of Science、Google scholar、Clinical Trials、CNKI、CBM、VIP及WanFang数据库,筛选有关中药联合针灸治疗脑卒中后吞咽障碍的随机对照研究(RCT),检索时间为建库到2023年11月。由2名研究者独立进行文献筛选、数据提取及纳入文献的质量评价,使用Stata12.0及RevMan5.3软件进行Meta分析。结果 共纳入22项RCT,1 816例患者。Meta分析结果显示:中药联合针灸治疗与针灸治疗和常规治疗相比,中药联合针灸治疗能提高有效率[RR=1.23,95%CI(1.18,1.28),P <0.000 01],降低洼田饮水试验评分[MD=-0.79,95%CI(-0.96,-0.62),P <0.000 01],提高患者Bartherl指数评分[MD=6.80,95%CI(3.18,10.41),P=0.000 2],降低SSA评分[MD=-4.84,95%CI(-6.39,-3.29),P <0.000 01]。结论 现有证据表明,与针灸治疗和常规治疗相比,中药联合针灸治疗脑卒中吞咽障碍有效性表现良好。受纳入研究数量的限制,上述结论还需开展更多、更高质量的临床试验予以验证。

Objective:To systematically evaluate the effectiveness of traditional Chinese medicine(TCM)combined with acupuncture in the treatment of post-stroke dysphagia.Methods:A comprehensive search was conducted in databases including PubMed,Embase,Cochrane Library,Web of Science,Google scholar,Clinical Trials,CNKI,CBM,VIP,and WanFang Data to identify randomized controlled trials(RCTs)on post-stroke dysphagia treated by TCM combined with acupuncture.The search period was from inception of the databases to November,2023.Two reviewers independently screened the literature,extracted data,and assessed the risk of bias of included studies;analysis was performed using Statal2.0 and Revman5.3 software.Results:A total of 22 RCTs studies involving 1816 patients were included.Meta-analysis results showed that compared with acupuncture and conventional treatment,the combination of TCM with acupuncture could improve the effective rate[RR=1.23,95%CI(1.18,1.28),P<0.00001],decrease the scores of Kubota's water swallow test[MD=-0.79,95%CI(-0.96,-0.62),P<0.00001],increase the Barthel Index score[MD=6.80,95%CI(3.18,10.41),P=0.0002],and reduce the Standardized Swallowing Assessment(SSA)scores[MD=-4.84,95%CI(-6.39,-3.29),P<0.00001].Conclusion:The current evidence show that,compared with acupuncture and conventional treatment,the combination of TCM and acupuncture for treating post-stroke dysphagia can demonstrate good efficacy.Due to the limited quantity of the included studies,more high-quality studies are needed to verify the above conclusion.