刮痧改善腰椎间盘突出疼痛症状的系统评价及GRADE证据质量评价  

Systematic Evaluation of Scraping Therapy for Pain Symptoms in Lumbar Disc Herniation and GRADE Evidence Quality Evidence

作　　者：高玉洁 王佳怡 葛浩天 徐桂华[1] 杨敏[1] 姜荣荣[1] 陈华[1] GAO Yujie;WANG Jiayi;GE Haotian;XU Guihua;YANG Min;JIANG Rongrong;CHEN Hua(School of Nursing,Nanjing University of Chinese Medicine,Nanjing 210046,China)

机构地区：[1]南京中医药大学护理学院,南京210046

出　　处：《世界科学技术-中医药现代化》2024年第2期419-428,共10页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：江苏省卫生健康委员会科研项目(Z2022026):基于计算机视觉的腰椎间盘突出症多尺度痧象特征提取和识别研究,负责人:姜荣荣;江苏省教育厅自然科学面上项目(21KJB360024):基于计算机视觉的痧象三维特征、证候及疗效的相关性研究——以腰椎间盘突出症为例,负责人:姜荣荣;江苏省教育厅研究生科研创新计划(KYCX23_2199):基于PHD2/HIF-1α通路探究刮痧干预神经根炎性痛大鼠的效应机制,负责人:高玉洁。

摘　　要：目的系统评价刮痧干预腰椎间盘突出疼痛症状的疗效与安全性,为其临床治疗提供循证依据。方法计算机检索自建库到2022年8月29日前公开发表在中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Embase、Web of Science、The Cochrane Library数据库,收集关于刮痧干预腰椎间盘突出的随机对照试验(Randomized controlled trial,RCT)。文章由两名研究者独立筛选,根据Cochrane Reviewers Handbook 6.2的偏倚风险评估工具对纳入文献进行质量评价,应用RevMan 5.4软件对纳入文献的结局指标进行Meta分析,并采用GRADE系统对结局指标进行证据质量等级评价。结果最终纳入10篇RCT,共1087例患者。Meta分析结果显示:刮痧试验组治疗腰椎间盘突出患者在疼痛VAS评分[MD=-1.11,95%CI(-1.58,-0.64),P<0.00001]、日本骨科协会(JOA)评分[MD=4.47,95%CI(3.76,5.17),P<0.00001]、临床有效率[relative risk(RR)=1.13,95%CI(1.08,1.19),P<0.00001]和护理满意度[RR=1.21,95%CI(1.09,1.34),P=0.0005]方面,明显优于对照组,差异均有统计学意义(P<0.00001)。本文结局指标的证据质量为极低。结论当前证据表明,刮痧治疗腰椎间盘突出患者的疼痛症状具有良好临床疗效,并有助于提高临床护理满意度。由于部分结局证据质量较低,有待严谨的多中心、大样本随机对照试验来进一步验证其有效性,提升临床证据。Objective To systematically evaluate the efficacy and safety of scraping therapy for pain symptoms in lumbar disc herniation(LDH).Methods Randomized controlled trials(RCTs)on scraping therapy for LDH were identified from databases of China National Knowledge Infrastructure Database(CNKI),WanFang Digital Journal(WanFang),China Science and Technology Journal Database(VIP),SinoMed,PubMed,Embase,Web of Science and The Cochrane Library from the establishment of databases to 29 August,2022.Articles were screened independently by two investigators,and the methodological quality of eligible studies was critically evaluated according to the Cochrane risk-of-bias tool for randomized trials(RoB2).Outcomes were analyzed by Review Manager 5.4 software.The quality of evidence was evaluated according to Grades of Recommendation,Assessment,Development and Evaluation(GRADE)standards.Results A total of 10 RCTs involving 1087 patients were analyzed through screening.Results of Metaanalysis demonstrated that patients who received scraping treatment showed significant improvement in the VAS score[MD=-1.11,95%CI(-1.58,-0.64),P<0.00001],JOA score[MD=4.47,95%CI(3.76,5.17),P<0.00001],the total effective rate[RR=1.13,95%CI(1.08,1.19),P<0.00001]and patients'satisfaction with nursing[RR=1.21,95%CI(1.09,1.34),P=0.0005]when compared to those in the control group(P<0.00001).The quality of evidence for outcomes measured was very low.Conclusion Existing evidence shows that scraping treatment can alleviate patients'pain,and increase their satisfaction with clinical nursing.However,given the low quality of evidence,the clinical evidence must be further validated by rigorous multi-center,large-sample RCTs.

关 键 词：刮痧 腰椎间盘突出 系统评价 META分析 GRADE 

分 类 号：R-058[医药卫生]