4种针刺疗法治疗中风后肩手综合征的网状Meta分析  

Network Meta-analysis of 4 acupuncture therapies for shoulder hand syndrome after stroke

作　　者：王瑞奇 吴清忠 黄春华[2] 饶旺福[2] WANG Rui-qi;WU Qing-zhong;HUANG Chun-hua;RAO Wang-fu(Graduate School of Jiangxi University of TCM,Nanchang 330006,China;Affiliated Hospital of Jiangxi University of TCM,Nanchang 330006)

机构地区：[1]江西中医药大学研究生院,南昌330006 [2]江西中医药大学附属医院,南昌330006

出　　处：《中国针灸》2021年第5期563-569,共7页Chinese Acupuncture & Moxibustion

基　　金：国家中医药管理局全国名老中医药专家传承工作室建设项目:国中医药人教发[2016]42。

摘　　要：目的:对常用的4种针刺疗法(电针、火针、温针和毫针)治疗中风后肩手综合征(SHS)的随机对照试验(RCT)进行网状Meta分析。方法:计算机检索中国期刊全文数据库(CNKI)、万方数据库(Wanfang)、维普数据库(VIP)、中国生物医学文献数据库(SinoM ed)、PubM ed、EMbase和Cochrane Library中电针、火针、温针和毫针治疗中风后SHS的随机对照试验,检索时限为建库至2020年3月10日。采用Cochrane偏倚风险评估工具对纳入文献进行筛选和质量评价,运用Rev Man5.3、Gemtc0.14.3和Stata14.2进行数据分析。结果:最终纳入21项RCT,共纳入病例1508例,其中试验组814例,对照组694例。(1)有效率和视觉模拟量表(VAS)评分:温针、电针、火针均优于西药和康复(P<0.05),且温针成为最佳治疗措施的可能性最大;(2)关节肿胀评分:温针优于康复(P<0.05),且温针成为最佳治疗措施的可能性最大;(3)Fugl-Meyer评定量表(FMA)评分:火针优于西药和康复(P<0.05),温针优于毫针(P<0.05),火针成为最佳治疗措施的可能性最大(P<0.05)。结论:4种针刺治疗中风后SHS疗效总体均优于西药和康复,且温针体现了最佳临床疗效。Objective A network Meta-analysis of randomized controlled trials(RCT) of 4 commonly used acupuncture therapies(electroacupuncture, fire needling, warming acupuncture and filiform needling) for shoulder hand syndrome(SHS) after stroke was performed. Methods The RCTs regarding electroacupuncture, fire needling, warming acupuncture and filiform needling for SHS after stroke before March 10, 2020 were searched in databases of CNKI, Wanfang, VIP, SinoMed, PubM ed, EMbase and Cochrane Library. The included literature was screened and evaluated by Cochrane bias risk assessment tool, and the data analysis was performed by RevMan5.3, Gemtc0.14.3 and Stata14.2. Results A total of 21 RCTs were included, involving 1508 patients, 814 cases in the observation group and 694 cases in the control group. In term of effective rate and visual analogue scale(VAS) score, warming acupuncture, electroacupuncture and fire needling needling were superior to western medication and rehabilitation(P<0.05), and warming acupuncture was most likely to be the best treatment. In term of joint swelling score, warming acupuncture was superior to rehabilitation(P<0.05), and warming acupuncture was most likely to be the best treatment. In term of Fugl-Meyer assessment(FMA) score, fire needling was superior to western medication and rehabilitation(P<0.05), warming acupuncture was superior to filiform needling(P<0.05), fire needling was most likely to be the best treatment(P<0.05). Conclusion The curative effect of 4 acupuncture therapies for SHS after stroke is better than the western medication and rehabilitation, and warming acupuncture has the best clinical efficacy.

关 键 词：肩手综合征 中风 针刺 电针 火针 温针 网状Meta分析 

分 类 号：R245[医药卫生—针灸推拿学]