目的通过文献定量学分析探讨电针疗法及其不同治疗参数对于尿失禁女性症状的改善和生活质量提高方面的影响。方法通过对中英文8大数据库PubMed、Cochrane library、Web of Science、Embase、中国知网(CNKI)、万方数据库(Wanfang)、重庆...目的通过文献定量学分析探讨电针疗法及其不同治疗参数对于尿失禁女性症状的改善和生活质量提高方面的影响。方法通过对中英文8大数据库PubMed、Cochrane library、Web of Science、Embase、中国知网(CNKI)、万方数据库(Wanfang)、重庆维普数据库(VIP)以及中国生物医学文献服务数据库(SinoMed)的检索,根据本研究纳排标准纳入文献,并进行文献风险偏倚评估。使用Stata15.1软件对所纳入研究的各项数据合并分析,评估电针疗法治疗女性尿失禁的临床疗效,并且通过5个亚组的亚组分析(尿失禁类型、选穴、对照组、电针仪波形、疗程5个方面),探讨可能的电针疗法优势参数。结果电针疗法对于改善女性尿失禁患者的生活质量、减少漏尿量及漏尿频率、延长憋尿时间等方面均有优势治疗作用,且疗效优于临床中其他治疗方法。在电针治疗优势参数的选择方面,电针疗法对于压力性女性尿失禁患者具有明显优势的治疗效果,但电针疗法在治疗混合性尿失禁方面的优势仍需更多临床证据。临床中穴位的选择可能以会阳、中髎穴为治疗优势穴位,电针仪波形中连续波效果更佳,且6周左右的疗程可能成为优势疗程选择。讨论纳入的13项研究在实验组干预方式和研究对象一致性高,并且风险偏倚等级较小保证了整体模型的稳定性,并且治疗穴位、疗程、对照组方面具备亚组分析的多元性。结果提示电针疗法对于女性尿失禁患者生活质量的提高、憋尿时间的延长、漏尿量和漏尿频率的减少比其他疗法可能促进作用,但不良事件发生率均有发生,临床中应根据患者症状差异确定治疗方案。整体模型不一致性高并且可能存在发表偏倚,这与纳入研究数量少以及没有限制对照组、选穴、疗程等因素有关。这也提示需要更多的高质量临床研究的报道,从而保证Meta分析的证据质量。亚组分析结果从宏观角度确立不同亚组模型,从而达到不同治疗参数疗效对比,但不能避免模型合并研究数过少、异质性大以及发表偏倚问题,但确实和临床预期有一致性,可进一步研究。展开更多
Stroke is the main cause of disability in the middle and old age.Hemiplegia,especially lower limb paralysis,often leads to the loss of self-care ability and a series of secondary injuries.The main method to improve he...Stroke is the main cause of disability in the middle and old age.Hemiplegia,especially lower limb paralysis,often leads to the loss of self-care ability and a series of secondary injuries.The main method to improve hemiplegic limb movement is exercise therapy,but there are still many patients with disabilities after rehabilitation treatment.As one of the non-pharmacological therapies for stroke,acupuncture has been recognized to improve motor function in patients.Here,we propose a new method,anterior sciatic nerve acupuncture,which can stimulate both the femoral nerve and the sciatic nerve.We designed this study to determine the effect of this method on lower limb motor function.Sixty participants recruited with hemiplegia after cerebral infarction will be randomly assigned to the test group or control group in a 1:1 ratio.The control group will receive Xingnao Kaiqiao acupuncture,and the test group will receive anterior sciatic nerve acupuncture on this basis.All participants will get acupuncture treatment once a day,6 times a week for 2 weeks.The primary outcome is Fugl-Meyer Assessment of Lower Extremity and the secondary outcomes are Modified Ashworth Scale and Modified Barthel Index.Data will be collected before treatment,1week after treatment,and 2 weeks after treatment,and then statistical analysis will be performed.This study can preliminarily verify the effect of anterior sciatic nerve acupuncture on improving lower limb motor function in patients with cerebral infarction,which may provide an alternative approach for clinical treatment of hemiplegia.展开更多
文摘目的通过文献定量学分析探讨电针疗法及其不同治疗参数对于尿失禁女性症状的改善和生活质量提高方面的影响。方法通过对中英文8大数据库PubMed、Cochrane library、Web of Science、Embase、中国知网(CNKI)、万方数据库(Wanfang)、重庆维普数据库(VIP)以及中国生物医学文献服务数据库(SinoMed)的检索,根据本研究纳排标准纳入文献,并进行文献风险偏倚评估。使用Stata15.1软件对所纳入研究的各项数据合并分析,评估电针疗法治疗女性尿失禁的临床疗效,并且通过5个亚组的亚组分析(尿失禁类型、选穴、对照组、电针仪波形、疗程5个方面),探讨可能的电针疗法优势参数。结果电针疗法对于改善女性尿失禁患者的生活质量、减少漏尿量及漏尿频率、延长憋尿时间等方面均有优势治疗作用,且疗效优于临床中其他治疗方法。在电针治疗优势参数的选择方面,电针疗法对于压力性女性尿失禁患者具有明显优势的治疗效果,但电针疗法在治疗混合性尿失禁方面的优势仍需更多临床证据。临床中穴位的选择可能以会阳、中髎穴为治疗优势穴位,电针仪波形中连续波效果更佳,且6周左右的疗程可能成为优势疗程选择。讨论纳入的13项研究在实验组干预方式和研究对象一致性高,并且风险偏倚等级较小保证了整体模型的稳定性,并且治疗穴位、疗程、对照组方面具备亚组分析的多元性。结果提示电针疗法对于女性尿失禁患者生活质量的提高、憋尿时间的延长、漏尿量和漏尿频率的减少比其他疗法可能促进作用,但不良事件发生率均有发生,临床中应根据患者症状差异确定治疗方案。整体模型不一致性高并且可能存在发表偏倚,这与纳入研究数量少以及没有限制对照组、选穴、疗程等因素有关。这也提示需要更多的高质量临床研究的报道,从而保证Meta分析的证据质量。亚组分析结果从宏观角度确立不同亚组模型,从而达到不同治疗参数疗效对比,但不能避免模型合并研究数过少、异质性大以及发表偏倚问题,但确实和临床预期有一致性,可进一步研究。
基金Supported by the National Key Research and Development Program of China:Evidence Based Study on the Treatment of Post Stroke Motor Aphasia with the Rehabilitation Plan of“Xing Nao Kai Qiao”(No.2018YFC1706001)。
文摘Stroke is the main cause of disability in the middle and old age.Hemiplegia,especially lower limb paralysis,often leads to the loss of self-care ability and a series of secondary injuries.The main method to improve hemiplegic limb movement is exercise therapy,but there are still many patients with disabilities after rehabilitation treatment.As one of the non-pharmacological therapies for stroke,acupuncture has been recognized to improve motor function in patients.Here,we propose a new method,anterior sciatic nerve acupuncture,which can stimulate both the femoral nerve and the sciatic nerve.We designed this study to determine the effect of this method on lower limb motor function.Sixty participants recruited with hemiplegia after cerebral infarction will be randomly assigned to the test group or control group in a 1:1 ratio.The control group will receive Xingnao Kaiqiao acupuncture,and the test group will receive anterior sciatic nerve acupuncture on this basis.All participants will get acupuncture treatment once a day,6 times a week for 2 weeks.The primary outcome is Fugl-Meyer Assessment of Lower Extremity and the secondary outcomes are Modified Ashworth Scale and Modified Barthel Index.Data will be collected before treatment,1week after treatment,and 2 weeks after treatment,and then statistical analysis will be performed.This study can preliminarily verify the effect of anterior sciatic nerve acupuncture on improving lower limb motor function in patients with cerebral infarction,which may provide an alternative approach for clinical treatment of hemiplegia.
