非药物干预改善脑卒中后失眠症状疗效的 网状Meta分析  

Efficacy of non-drug intervention in improving insomnia symptoms after stroke:a network Meta-analysis

作　　者：曾友 袁敏[2] 明晶 孙淑雅 李滔 ZENG You;YUAN Min;MING Jing;SUN Shuya;LI Tao(School of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China;Department of Emergency,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400011,China)

机构地区：[1]成都中医药大学护理学院,成都610072 [2]重庆市中医院急诊科,重庆400011

出　　处：《数理医药学杂志》2024年第7期509-525,共17页Journal of Mathematical Medicine

基　　金：国家自然科学基金面上项目(81973656)。

摘　　要：目的采用网状Meta分析方法评价非药物干预改善脑卒中后失眠症状的疗效。方法检索PubMed、The Cochrane Library、Embase、Web of Science、中国知网、万方、维普、中国生物医药文献数据库(CBM)中自建库至2024年5月有关非药物干预改善脑卒中后失眠症状的随机对照试验(randomized controlled trial,RCT),由两名研究人员对文献进行筛选、提取资料并评价纳入研究的偏倚风险后,采用Stata 15.0软件进行网状Meta分析。结果共纳入42项RCT,包括2945例患者,涉及9种非药物干预措施(耳穴贴压、高压氧疗法、重复经颅磁刺激、穴位贴敷、中药浴足、针刺疗法、电针、五音疗法、艾灸)。网状Meta分析结果显示,在PSQI评分方面,中药浴足[MD=-3.70,95%CI(-6.04,-1.36)]、电针[MD=-3.50,95%CI(-5.36,-1.64)]、重复经颅磁刺激[MD=-3.33,95%CI(-4.70,-1.95)]、针刺疗法[MD=-2.95,95%CI(-3.72,-2.19)]、耳穴贴压[MD=-2.93,95%CI(-4.38,-1.47)]效果优于镇静安眠西药(P<0.05),中药浴足效果最佳;在总有效率方面,电针[OR=6.32,95%CI(2.97,13.47)]、针刺疗法[OR=4.41,95%CI(3.01,6.48)]、耳穴贴压[OR=3.63,95%CI(1.91,6.87)]优于镇静安眠西药(P<0.05),电针效果最佳。结论现有证据表明,中药浴足在改善脑卒中后睡眠质量的PSQI评分方面,以及电针在改善脑卒中后失眠症状的总有效率方面具有一定优势,但此结论仍需更多高质量、大样本的RCT进一步验证。Objective To evaluate the efficacy of non-drug intervention in improving insomnia symptoms after stroke by a network Meta-analysis.Methods PubMed,The Cochrane Library,Embase,Web of Science,CNKI,WanFang Data,VIP and CBM were searched for the randomized controlled trials(RCTs)about the improvement of post-stroke insomnia symptoms by non-drug intervention from the inception of the databases to May 2024.Two researchers screened the literature,extracted data,and evaluated the risk of bias of the included studies.Stata 15.0 software was used to perform a network Meta-analysis.Results A total 42 RCTs,including 2945 patients,involving nine non-pharmaceutical interventions(auricular application pressure,hyperbaric oxygen therapy,repetitive transcranial magnetic stimulation,point application,Chinese medicine foot bath,acupuncture,acusector,five-tone therapy,moxibustion).Results of the network Meta-analysis showed that,in the aspects of PSQI scores,the effects of Chinese medicine foot bath[MD=-3.70,95%CI(-6.04,-1.36)],acusector[MD=-3.50,95%CI(-5.36,-1.64)],repetitive transcranial magnetic stimulation[MD=-3.33,95%CI(-4.70,-1.95)],acupuncture[MD=-2.95,95%CI(-3.72,-2.19)]and auricular application pressure[MD=-2.93,95%CI(-4.38,-1.47)]were better than that of western medicine for sedation and sleep(P<0.05).The effect of Chinese medicine foot bath was the best.In terms of total effective rate,acusector[OR=6.32,95%CI(2.97,13.47)],acupuncture[OR=4.41,95%CI(3.01,6.48)]and auricular application pressure[OR=3.63,95%CI(1.91,6.87)]were superior to western medicine for sedation and sleep(P<0.05).Acusector had the best effect.Conclusion The existing evidence showed that Chinese medicine foot bath could improve the PSQI score of sleep quality after stroke,and acusector had certain advantages in improving the total effective rate of insomnia symptoms after stroke,but more high-quality and large sample randomized controlled studies are needed to further verify this conclusion.

关 键 词：脑卒中 失眠 非药物干预 网状Meta分析 随机对照试验 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R740[医药卫生—临床医学] G353.1[文化科学—情报学]