经筋刺法治疗脑卒中后痉挛性瘫痪疗效的Meta分析  

Meta-analysis on the Therapeutic Effect of Acupuncture at Meridian Sinew for Spastic Paralysis After Stroke

作　　者：张瑜[1] 马铁明[1] 白增华[1] 孙博文[1] 赵洪毅[1] ZHANG Yu MA Tie-ruing BAI Zeng-hua SUN Bo-wen ZHAO Hong-yi(School of Acupuncture, Moxibustion and Tuina ,Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China)

机构地区：[1]辽宁中医药大学针灸推拿学院,沈阳110032

出　　处：《针刺研究》2017年第2期178-182,共5页Acupuncture Research

摘　　要：目的:系统评价经筋刺法治疗脑卒中后痉挛性瘫痪的临床疗效。方法:以"经筋""脑卒中""痉挛"等相关词为检索词,检索中国学术期刊全文数据库(1979年-2015年)、维普数据库(1989年-2015年)、中国生物医学数据库(1978年-2015年)、万方数据库(1989年-2015年)、PubMed(1980年-2015年)、The Cochrane Library(Issue 4,2015年)。通过Cochrane系统的偏倚风险评估工具对文献进行方法学质量评价。利用RevMan 5.3软件进行Meta分析。结果:共纳入文献13篇,合计820名患者。根据Cochrane协作网系统评价员手册(5.0.2版)对随机对照试验进行偏倚风险的评估,13篇文献均是偏倚风险不确定。Meta分析结果:总有效率对比,OR合并=3.86,95%CI为[2.67,5.57],合并效应量检验,Z=7.20,P<0.00001,差异具有统计学意义,经筋刺法优于传统针刺法;改良Ashworth痉挛量表对比,OR合并=4.54,95%CI为[2.91,7.10],合并效应量检验,Z=6.64,P<0.00001,差异具有统计学意义,经筋刺法优于传统针刺法;Fugl-Meyer肢体运动功能评分,MD合并=4.18,95%CI为[-0.59,8.94],合并效应量检验,Z=1.72,P=0.09>0.05,差异无统计学意义。纳入文献发表性偏倚不明显,对合并效应量的影响可以忽略。结论:经筋刺法治疗中风后痉挛性瘫痪有效,总体临床疗效及改善肌张力均优于传统针刺法。由于纳入文献的质量普遍不高,尚待更多高质量、设计规范严谨的临床研究加以验证。Objective To review systematically the clinical effects of spastic paralysis after stroke treated with acu- puncture at meridian sinew （＂Jingjin＂, musculotendon）. Methods ＂Meridian sinew stroke＂ and ＂spasm＂ were taken as the key words to retrieve from the Chinese National Knowledge Infrastracture Database （CNKI）, Chongqing VIP Chinese Science and Technology Periodical Database （VIP）, Chinese Biomedical Library （CBM）, Wanfang Data, PubMed and the Cochrane Library. The Cochrane＂risk of bias＂ tool was used to conduct the methodological quality evaluation to the literature. RevMan 5.3 software was adopted for Meta-analysis. Results Totally, 13 papers were included, with 820 patients involved. In reference to Cochrane Reviewers＇ Handbook 5.0.2, the randomized controlled trial （RCT） risk of bias was assessed and it was unclear for all of the 13 papers. The results of Meta-analysis showed that the clinical effect was improved with acupuncture at meridian sinew as compared with normal acupuncture technique EGtotal effective rate： OR = 3.86, 95 % CI （2.67,5.57）, Z = 7.20, Pal0. 00001 ; （2）modi- fled Ashworth spasm scale： OR=4.54, 95% CI （2.91,7.10）, Z=6.64, P〈0.00001~ （3）evaluation of limb motor function with FugI-Meyer score, MD= 4.18, 95 % CI （ - 0.59,8.94）, Z = 1.72, P = 0. 09〉0. 05]. The publication bias of included papers was not obvious and therefore it could be neglected in the impact on the combined effect size. Conclusion Acupuncture at me- ridian sinew is effective in the treatment of spastic paralysis after stroke. The total clinical effect and the improvement in muscular tone with acupuncture at meridian sinew are better than those with normal acupuncture technique. The quality of the included litera- ture is not high generally. Hence, it is necessary to have more clinical studies with high-quality and strict design,

关 键 词：经筋刺法 脑卒中 痉挛性瘫痪 系统评价 META分析 

分 类 号：R245.329[医药卫生—针灸推拿学]