针刺治疗急性脑卒中随机或半随机对照试验的Cochrane系统评价  

Acupuncture in the treatment of acute stroke: a Cochrane system evaluation of randomized or semi-randomized controlled trials

作　　者：张世洪[1] 刘鸣[1] 李林[2] 

机构地区：[1]四川大学华西医院神经内科,四川省成都市610041 [2]四川大学华西医院针灸科,四川省成都市610041

出　　处：《中国临床康复》2005年第9期108-110,共3页Chinese Journal of Clinical Rehabilitation

基　　金：Cochrane图书馆注册课题;获中国循证医学中心及美国纽约中国医学部资助~~

摘　　要：目的:评价脑卒中急性期针刺治疗的临床疗效和安全性。方法:采用Cochrane系统评价的方法对针刺治疗急性脑卒中的随机或半随机对照试验进行系统评价。检索范围包括:Cochrane脑卒中组临床试验数据库(2003-08)、中国脑卒中临床试验数据库(2003-08)、中国针刺临床试验数据库(2003-08)、Cochrane图书馆临床对照试验数据库(2003年3期)、MEDLINE(1966/2003)、CINAHL(1982/2003)、EMBASE(1980/2003)、AMED(AlternativeMedicineDatabase)(1985/2003)、中国生物医学文献数据库(1981/2003)以及所有检索到文章的参考文献。结果:14篇研究(共1208例患者)符合纳入标准,其中仅3篇采用假针刺作为对照的研究方法学质量较高。Meta分析的结果显示,与对照(假针刺和不作针刺)组相比,针刺组随访期末的病死或残疾人数降低,差异达统计学显著性意义的临界值(OR=0.66,95%CI:0.43～0.99,P=0.05),针刺组随访期末病死或需要住院人数显著降低(OR=0.58,95%CI:0.35～0.96),治疗结束时全面神经功能缺损评分显著改善(SMD=1.17,95%CI:0.30～2.04)。当针刺与假针刺进行单独比较时,两组随访期末的病死或残疾人数及全面神经功能缺损评分变化无显著差异犤OR=0.67,95%CI:0.40～1.12;SMD=0.01,95%CI:(-0.55)～0.57犦。针刺严重不良反应发生率较低(6/AIM:To assess the clinical effectiveness and safety of acupuncture in patients with acute stroke.METHODS:A Cochrane system evaluation was used to evaluate the randomized or semi- randomized trials of acupuncture for acute stroke.The searching area included:Cochrane Stroke Group Clinical Trials Database(August 2003),the Chinese Stroke Clinical Trials Database(August 2003),the Chinese Acupuncture Clinical Trials Database(August 2003),the Cochrane Clinical Controlled Trials of Library(Issue 3,2003), MEDLINE(1966- 2003),CINAHL(1982- 2003),EMBASE(1980- 2003),Alternative Medicine Database(1985- 2003),the Chinese Biological Medicine Database(1981- 2003) and reference lists of all identified studies.RESULTS:Fourteen trials involving 1 208 patients met the inclusion criteria.Only three trials using sham acupuncture as control were of relatively high quality.The results of Meta analysis indicated that the number of death and disabled persons decreased in acupuncture group at the end of follow- up as compared with control group(sham acupuncture or without acupuncture),and the differences reached to the borderline of statrstical significance[odds rate(OR):0.66,95% confidence interval(CI): 0.43- 0.99,P=0.05]. Patients being dead or needing admission was reduced(OR: 0.58, 95% CI: 0.35- 0.96) in acupuncture group at the end of follow- up.Global neurologic impairment improved dramatically at the end of treatment(standardized mean difference:1.17, 95% CI:0.30- 2.04).When acupuncture was compared with only sham acupuncture,there was no significant difference in the number of death and disabled persons and global neurologic impairment at the end of follow- up between the two groups(OR:0.67,95% CI:0.40- 1.12, standardized mean difference:0.01, 95% CI:- 0.55- 0.57). The incidence of severe adverse events of acupuncture was lower(6/386, 1.6% ). CONCLUSION:The number of patients is too small to definitely determine whether or not acupuncture is effective in the treatment of acute stroke.Acupuncture is a relative safe method.Larger

关 键 词：脑血管意外 针刺疗法 评价研究 

分 类 号：R743[医药卫生—神经病学与精神病学]