针刺治疗颈源性头痛疗效的系统评价  

ACUPUNCTURE TREATMENT FOR THE OF CERVICOGENIC HEADACHE: A SYSTEMATIC REVIEW

作　　者：张凯[1] 刘宇[2] 蒋戈利[1] 

机构地区：[1]中国人民解放军第四六四医院全军中医针灸康复技术中心,天津300381 [2]中国人民解放军第四六四医院消化科,天津300381

出　　处：《中国疼痛医学杂志》2013年第11期643-647,共5页Chinese Journal of Pain Medicine

基　　金：天津市卫生局中医中西医结合科研课题(No.13147)

摘　　要：目的:系统评价针刺治疗颈源性头痛的有效性和安全性。方法:计算机检索CBM(1979至2012年)、CNKI(1979至2012年)、VIP(1989至2012年)、万方数字化期刊群(1998至2012年)、PubMed(1966至2012年)、EMbase(1980至2012年)和Cochrane Library(Issue 4,2012)数据库,并辅以手工检索,纳入针刺与口服药物比较治疗颈源性头痛的随机或对照试验。由两名评价者独立提取资料并交叉核对,而后按照Cochrane系统评价员手册4.2.8进行质量评估,采用RevMan 5.0软件进行Meta分析。结果:共查到相关文献79篇,最终纳入8个随机对照试验,包括1177例患者。Meta分析结果显示:(1)有效率:①针刺与非甾体类抗炎药物疗效比较在有效率方面差异有统计学意义[RR=1.41,95%CI(1.18,1.69)],针刺组的疗效优于非甾体类抗炎药物组。②针刺与非甾体类抗炎药+肌肉松弛剂在有效率方面比较差异无统计学意义[RR=1.36,95%CI(0.75,2.50)]。③针刺与氟桂利嗪的治疗颈源性头痛的有效率方面比较差异有统计学意义[RR=1.29,95%CI(1.05,1.58)],针刺组的疗效优于氟桂利嗪组。④针刺与神经阻滞+扶他林治疗颈源性头痛的有效率方面比较差异无统计学意义[RR=1.08,95%CI(0.97,1.21)]。(2)治疗前后的视觉模拟评分(visual analogue scale,VAS)指标变化:针刺与非甾体类抗炎药物或联合肌肉松弛剂治疗VAS评分的比较,差异无统计学意义[RR=1.77,95%CI(-0.14,3.67)]。结论:针刺治疗颈源性头痛安全、有效。针刺在快速缓解疼痛方面优于止痛药物。但因纳入文献数量有限且部分研究质量较低,上述结论需更多高质量的随机对照试验来进一步验证。Objective：To systematically assess the efficacy and safety of acupuncture for the treatment of cervicogenic headache.Methods：Randomized controlled trials（RCTs） involving acupuncture for the treatment of cervicogenic headache were identifed from CBM（1978 to 2012）,VIP（1989 to 2012）,Wanfang Database（1998 to 2012）,CNKI（1979 to 2012）,PubMed（1966 to 2012）,EMbase（1980 to 2012）,and the Cochrane Library（Issue 4,2012）.Some relevant journals were hand-searched.Data were extracted by two reviewers independently and went through crosscheck.Data quality was evaluated with Cochrane Reviewer＇ s Manual 4.2.8.The Cochrane Collaboration＇ s RevMan 5.0 software was used for meta-analyses.Results：A total of 8 trials involving 1177 patients were included.（1） The effective rate： ① Effect of the acupuncture group is signifcantly better than that of non steroidal anti-infammatory drug group [RR=1.41,95% CI（1.18,1.69）].②There was no statistically significant difference between acupuncture and non steroidal anti-inflammatory plus muscle relaxant drug group [RR=1.36,95%CI（0.75,2.50）].③ Effects of the acupuncture group is signifcantly better than that of Flunarizine drug group [RR=1.29,95%CI（1.05,1.58）].④ There was no statistically significant difference between acupuncture and nerve block plus votalin [RR=1.08,95%CI（0.97,1.21）].（2） The changes in visual analogue scale（VAS） scores： The score of VAS of headache and cervicodynia had no signifcant differences between acupuncture and non-steroidal anti-infammatory drugs or combined with muscle relaxants [RR=1.77,95%CI（-0.14,3.67）].Conclusion：Acupuncture therapy is safe and effective in the treatment of cervicogenic headache.Acupuncture may be superior to western drugs in rapid alleviation of pain.However,because of the defects in the methodological quality of the included trials,the conclusion is to be confrmed by more high quality RCTs.

关 键 词：针刺方法 疗法 颈源性头痛 系统评价 

分 类 号：R246[医药卫生—针灸推拿学]