中医外治疗法改善癌症患者阿片类药物相关性便秘的网状Meta分析

Network meta-analysis of the efficacy of external traditional Chinese medicine treatments for alleviating opioid-induced constipation in cancer patients

目的使用网状meta分析评价不同中医外治疗法改善癌症患者阿片类药物相关性便秘(opioid-induced constipation,OIC)的效果。方法计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、中国生物医学文献数据库、中国知网、万方期刊数据库及维普数据库,检索时间为建库至2023年8月28日。由2名研究者独立进行文献的筛选、质量评价、数据提取,运用Stata MP 17.0软件实施数据分析。结果共纳入53项研究,涉及15种中医外治疗法,共5263例患者。网状meta分析结果显示:针刺、穴位敷贴、低频电针、穴位注射、中药灌肠、穴位热熨、耳穴压贴、灸法、针灸、揿针、超声药透均优于常规治疗,差异均有统计学意义(P<0.05);穴位敷贴、穴位注射、穴位热熨均优于经皮穴位电刺激,差异均有统计学意义(P<0.05)。疗效排序结果显示:在治疗肿瘤患者OIC的效果上,穴位注射效果最佳的可能性最大。结论中医外治疗法能够有效改善癌症患者OIC,其中穴位注射疗法效果最佳,其次为针灸、揿针、穴位热熨,但未来仍需要大样本、高质量的研究进一步证实。

Objective To evaluate the efficacy of various external Chinese medicine treatments in alleviating opioid-associated constipation(OIC)in cancer patients using a reticulated meta-analysis.Methods PubMed,Web of Science,The Cochrane Library,Embase,China Biomedical Literature Database,China National Knowledge Infrastructure,Wanfang Data,and VIP database were searched by computer,and the retrieval time was from the establishment of the database to August 28,2023.The literature screening,quality evaluation,and data extraction were independently conducted by 2 researchers,and Stata MP 17.0 software was used for data analysis.Results A total of 53 studies were included,involving 15 types of external Chinese medicine treatments,with a total of 5,263 patients.The results of network meta-analysis indicated that needling,acupoint application,low-frequency electro-acupuncture,acupoint injections,herbal enema,acupoint heat ironing,auricular acupoint pressure paste,moxibustion,acupuncture,pressing acupuncture,and ultrasonic drug permeation were superior to conventional treatment,with statistically significant differences(P<0.05);Acupoint application,acupoint injections,and acupoint heat ironing were superior to percutaneous acupoint electrostimulation,and the differences were all statistically significant(P<0.05).The results of the efficacy ranking showed that in the effect of treating OIC in tumor patients,acupoint injection had the highest possibility of the best effect.Conclusions External Chinese medicine treatments can effectively improve OIC in cancer patients,with acupoint injection therapy being the most effective,followed by acupuncture,pressing acupuncture,and acupoint heat ironing,but large-sample,high-quality studies are needed to further confirm in the future.