非药物治疗改善脑卒中后失眠疗效的网状Meta分析

A Network Meta-analysis of the Efficacy of Non-pharmacological Interventions to Improve Insomnia After Stroke

目的采用网状Meta分析评价非药物在治疗改善卒中后失眠的疗效。方法检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Pubmed、Cochrane Library、Web of science、Embase中关于非药物治疗PSI的随机对照试验,检索时限均限为2023年7月。由2名研究者对文献进行筛选和数据提取。运用RevMan 5.3、Stata 17.0软件进行数据处理和网状Meta分析。结果共纳入文献38篇,总样本量3054例,涉及9种干预措施(针刺疗法、耳穴压豆疗法、耳针疗法、耳穴揿针疗法、头皮针疗法、针灸疗法、切脉针灸疗法、重复经颅刺激疗法、生物反馈疗法)。网状Meta分析结果显示,除艾灸疗法外,7种干预措施在改善卒中后失眠患者临床总有效率方面效果均优于对照组,差异具有统计学意义(P<0.05),8种非药物干预措施改善临床总有效率的SUCRA从大到小依次为:切脉针灸疗法(75.2%)>头皮针疗法(61.3%)>耳针疗法(61.1%)>针灸疗法(56.7%)>艾灸疗法(55.4%)>针刺疗法(51.3%)>耳穴压豆疗法(45.3%)>耳穴揿针疗法(42.4%)>常规治疗(1.3%);除艾灸疗法、生物反馈疗法及头皮针疗法以外,4种非药物治疗在改善卒中后失眠患者的PSQI评分效果优于对照组,7种非药物干预措施改善PSQI评分方面SUCRA从大到小依次为:切脉针灸疗法(84.0%)>耳穴压豆疗法(69.7%)>重复经颅磁刺激疗法(56.3%)>生物反馈疗法(54.6%)>艾灸疗法(50.3%)>针刺疗法(45.8%)>头皮针疗法(36.0%)>常规治疗(3.4%)。结论现有证据表明,针刺疗法、耳穴压豆疗法、耳针疗法、耳穴揿针疗法、头皮针疗法、针灸疗法、切脉针灸疗法在提高PSI患者临床总有效率的方面效果高于常规治疗,其中切脉针灸效果最好;针刺疗法、耳穴压豆疗法、重复经颅磁刺激疗法、切脉针灸疗法在改善PSI患者睡眠质量方面效果优于对照组,其中切脉针灸效果最佳。

Objective To evaluate the efficacy of non-drug treatment for insomnia after stroke by using mesh meta-analysis.Methods Previous studies of randomized controlled trials on PSI in CNKI,Wanfang Database,VIP database,Chinese Biomedical Literature database,Pub med,Cochrane Library,Web of science and Embase were searched,and the search time limit was up to July 2023.Literature screening and data extraction were carried out by two researchers.Data processing and mesh meta-analysis were performed by Rev Man 5.3 and Stata 17.0 software.Results A total of 38 literatures were identified and included for the analysis.The total sample size was 3054 cases,involving 9 types of intervention measures(acupuncture therapy,ear point pressure bean therapy,ear acupuncture therapy,ear point press acupuncture therapy,scalp acupuncture therapy,acupuncture therapy,pulse acupuncture therapy,repetitive transcranial stimulation therapy,and biofeedback therapy).The results of mesh meta-analysis showed that,except for moxibustion therapy,7 interventions were superior to the control group in improving the total clinical effective rate of patients with insomnia after stroke with the significant difference(P<0.05).SUCRA of 8 non-drug interventions in improving the total clinical effective rate was as follows in a descending order:pulse-cutting acupuncture therapy(75.2%)>scalp acupuncture therapy(61.3%)>ear acupuncture therapy(61.1%)>acupuncture therapy(56.7%)>moxibustion therapy(55.4%)>acupuncture therapy(51.3%)>ear point compression bean therapy(45.3%)>ear point acupuncture therapy(42.4%)>conventional treatment(1.3%);In addition to moxibustion therapy,biofeedback therapy and scalp acupuncture therapy,the effect of four non-drug treatments in improving PSQI score of insomnia patients after stroke was better than that of the control group.SUCRA of seven non-drug interventions in improving PSQI score was as follows in a descending order:pulse acupuncture(84.0%)>ear point pressure bean therapy(69.7%)>repetitive transcranial magnetic stimulation(56.3%)>biofeedback therapy(54.6%)>moxibustion therapy(50.3%)>acupuncture therapy(45.8%)>scalp acupuncture therapy(36%)>conventional therapy(3.4%).Conclusion The available evidence shows that acupuncture therapy,auricular point compression therapy,auricular acupuncture therapy,auricular point press-acupuncture therapy,scalp acupuncture therapy,acupuncture therapy,and pulse acupuncture therapy are more effective than the conventional treatment in improving the clinical total effective rate of PSI patients,and pulse acupuncture is the most effective one.Acupuncture therapy,auricular point pressure bean therapy,repetitive transcranial magnetic stimulation therapy and pulse acupuncture therapy are better than the control group in improving the sleep quality of PSI patients,and pulse acupuncture shows the best effect.