耳针疗法治疗失眠的系统评价和Meta分析  

Systematic review and Meta-analysis on the auriculotherapy in treatment of insomnia

作　　者：焦玥 韩颖[2] 周劲草[2] 张金铃[2] 赵亚楠[2] 荣培晶 JIAO Yue;HAN Ying;ZHOU Jin-cao;ZHANG Jin-ling;ZHAO Ya-nan;RONG Pei-jing(Department of TCM,Hospital of Tsinghua University,Beijing 100084,China;Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700)

机构地区：[1]清华大学医院中医科,北京100084 [2]中国中医科学院针灸研究所,北京100700

出　　处：《中国针灸》2022年第10期1184-1194,共11页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金面上项目:81473780;北京市市科委项目:Z161100002616003。

摘　　要：目的:系统评价耳针治疗失眠的临床疗效及安全性。方法:计算机检索PubMed、EMbase、Cochrane Library、Web of Science、中国期刊全文数据库(CNKI)、万方数据知识服务平台(Wanfang)、维普资讯中文期刊服务平台(VIP)、中国生物医学文献数据库(SinoMed)中耳针治疗失眠的随机对照试验(RCT)文献,检索时间从建库至2021年4月30日。采用RevMan5.3软件进行Meta分析。结果:共纳入38篇文献,共3707例患者。Meta分析结果表明:①耳针治疗失眠的有效率优于单用安眠西药(RR=1.26,95%CI:1.15~1.39,Z=4.77,P<0.00001)、常规针刺治疗(RR=1.10,95%CI:1.05~1.16,Z=3.83,P=0.0001)、中药治疗(RR=1.41,95%CI:1.23~1.63,Z=4.80,P<0.00001);②耳针治疗在降低PSQI总评分方面优于单用安眠西药治疗(MD=-1.61,95%CI:-2.61~-0.60,Z=3.14,P=0.002)、中成药治疗(MD=-3.76,95%CI:-4.84~-2.68,Z=6.84,P<0.00001),与常规针刺组比较差异无统计学意义(MD=-1.02,95%CI:-2.11~0.08,Z=1.82,P=0.07);③耳穴选择:迷走神经分布区耳穴为主治疗在降低PSQI总评分方面优于其他耳区穴位为主治疗(MD=-3.21,95%CI:-4.45~-1.96,Z=5.03,P<0.00001);④刺激物选择:使用不同刺激物(磁珠、王不留行籽、微针)治疗有效率比较差异无统计学意义(MD=1.62,95%CI:0.71~3.73,Z=1.14,P=0.25);⑤刺激频率:高频次刺激与低频次刺激耳穴在有效率、降低PSQI总评分方面比较差异无统计意义(P>0.05),但根据敏感性分析,结果需要谨慎对待;⑥不良反应:耳针(耳穴贴压)治疗较西药不良反应例数少(MD=0.15,95%CI:0.06~0.35,Z=4.38,P<0.0001)。结论:耳针治疗失眠较中西药治疗和常规针刺治疗有一定的疗效优势,可以改善失眠的相关症状,且不良反应少,但尚需更多高质量的随机对照试验进一步验证。Objective To review the effectiveness and safety of auriculotherapy in treatment of insomnia.Methods The articles were collated by computer retrieval from 8 databases from the initiation to April 30,2021,i.e.PubMed,EMbase,the Cochrane Library,the Web of Science,CNKI,Wanfang database,VIP and Chinese biomedical literature database(SinoMed).Meta-analysis was conducted with RevMan5.3 software.Results A total of 38 articles were included,with 3707 cases involved.The results showed:①The effective rate of auriculotherapy was better than that of single application of western medication with sleeping pills(RR=1.26,95%CI:1.15 to 1.39,Z=4.77,P<0.00001),conventional acupuncture(RR=1.10,95%CI:1.05 to 1.16,Z=3.83,P=0.0001)and Chinese herbal medicine(RR=1.41,95%CI:1.23 to 1.63,Z=4.80,P<0.00001),respectively.②The total score of PSQI was reduced remarkably under the auriculotherapy when compared with the single application of western medication(MD=-1.61,95%CI:-2.61 to-0.60,Z=3.14,P=0.002)and Chinese herbal medicine(MD=-3.76,95%CI:-4.84 to-2.68,Z=6.84,P<0.00001).But the difference was not significant when compared with conventional acupuncture(MD=-1.02,95%CI:-2.11 to 0.08,Z=1.82,P=0.07).③Auricular point selection:the auricular points distributed in the areas of vagus nerve were more advantageous in reducing PSQI score(MD=-3.21,95%CI:-4.45 to-1.96,Z=5.03,P<0.00001)compared with the points in other areas.④Stimulant selection:the difference in the effective rate was not significant among different stimulants(magnetic beads,the seeds of Vaccaria segetalis,micro-needles)(MD=1.62,95%CI:0.71 to 3.73,Z=1.14,P=0.25).⑤Stimulation frequency:there was no significant difference between high-frequency stimulation and low-frequency stimulation of auricular point sticking in improving the effective rate and reducing PSQI score(P>0.05).But the result should be considered cautiously in terms of the sensitivity analysis.⑥Adverse reactions:the case numbers of adverse reactions of auriculotherapy(auricular point sticking)were less than tho

关 键 词：失眠 耳针 系统评价 META分析 

分 类 号：R245.323[医药卫生—针灸推拿学]