针刺联合吞咽功能训练治疗脑卒中后吞咽困难的meta分析  

Meta analysis of acupuncture combined with swallowing function training in the treatment of dysphagia after stroke

作　　者：谭诗韵 廖军[2] 张利[3] 刘艳梅 白薇薇 TAN Shiyun;LIAO Jun;ZHANG Li;LIU Yanmei;BAI Weiwei(College of Nursing,Shaanxi University of Chinese Medicine,Shaanxi Province,Xianyang712046,China;College of Acupuncture,Fujian University of Traditional Chinese Medicine,Fujian Province,Fuzhou350122,China;Department of Acupuncture,the Second Affiliated Hospital,Shaanxi University of Chinese Medicine,Shaanxi Province,Xianyang712046,China;Department of Acupuncture,Shaanxi Traditional Chinese Medicine Hospital,Shaanxi Province,Xi'an710000,China)

机构地区：[1]陕西中医药大学护理学院,陕西咸阳712046 [2]福建中医药大学针灸学院,福建福州350122 [3]陕西中医药大学第二附属医院康复针灸科,陕西咸阳712046 [4]陕西省中医医院针灸科,陕西西安710000

出　　处：《中国医药导报》2020年第13期98-102,共5页China Medical Herald

基　　金：福建省自然科学基金资助项目(2019J01352);陕西省中医药管理局科研课题(LCMS019)。

摘　　要：目的评价针刺联合吞咽功能训练治疗脑卒中后吞咽困难的有效性与安全性。方法计算机检索中国知网、重庆维普、万方数据、PubMed、Cochrance Library和Embase数据库,时间为建库至2019年9月,筛选随机对照试验(RCT),采用RevMan 5.3软件对纳入的研究进行meta分析,采用Cochrane系统评价工具评估文献发表偏倚。结果共纳入12篇RCT,试验组临床总有效率高于对照组[RR=1.22,95%CI(1.15,1.29),Z=6.68,P<0.00001]。两组洼田饮水试验效果比较差异无统计学意义[SMD=-0.47,95%CI(-2.23,1.39),Z=0.50,P=0.62]。试验组洼田饮水试验效果(剔除后)优于对照组[SMD=-0.76,95%CI(-1.09,-0.43),Z=4.54,P<0.00001]。试验组的视频透视吞咽功能检查评分(VFSS)情况优于对照组[MD=1.54,95%CI(0.96,2.13),Z=5.19,P<0.00001]。试验组的VFSS情况(剔除后)仍优于对照组[MD=1.82,95%CI(1.37,2.28),Z=7.83,P<0.00001]。结论针刺联合吞咽功能训练治疗脑卒中后吞咽困难可取得较好的临床效果,改善患者症状,促进患者吞咽功能恢复。但纳入文献存在一定的发表偏倚,各研究间存在一定程度的异质性,样本量较少,试验设计不够严谨,仍需更多设计严谨的大样本量临床试验加以验证。Objective To evaluate the efficacy and safety of acupuncture combined with functional training in the treatment of dysphagia after stroke.Methods CNKI,VIP,Wanfang database,PubMed,Cochrance Library and Embase were retrieved from September 2019.Randomized controlled test(RCT)were selected,the included studies were analyzed with RevMan 5.3 software,and the publication bias was evaluated with Cochrane systematic evaluation tools.Results A total of 12 RCT were included.Clinical effect of experimental group was better than that of control group(RR=1.22,95%CI[1.15,1.29],Z=6.68,P<0.00001).The effect of drinking water test between the two groups had no significant difference(SMD=-0.47,95%CI[-2.23,1.39],Z=0.50,P=0.62).The effect of drinking water test(after elimination)in experimental group was better than that in control group(SMD=-0.76,95%CI[-1.09,-0.43],Z=4.54,P<0.00001).The video fluoroscopy swallowing study(VFSS)in experimental group was better than that in control group(MD=1.54,95%CI[0.96,2.13],Z=5.19,P<0.00001).VFSS(after elimination)in experimental group was better than that in control group(MD=1.82,95%CI[1.37,2.28],Z=7.83,P<0.00001).Conclusion Acupuncture combined with swallowing function training is a good clinical effect in treating dysphagia after stroke.However,the included literatures have a certain publication bias,high inter-study heterogeneity,and the trial design is not rigorous enough.Therefore,more well-designed large sample clinical trials are still needed to be verified.

关 键 词：针刺 吞咽功能训练 脑卒中 吞咽困难 META分析 

分 类 号：R743[医药卫生—神经病学与精神病学]