Acupuncture for spastic hemiplegia after ischemic stroke: a systematic review  

针刺治疗缺血性中风后痉挛性偏瘫:系统评价

作　　者：SHEN Fengjiao LUO Diantao SHEN Youhu SONG Mingxia HU Changshun ZHU Yuan CHEN Jing MAO An XIONG Bingye XU Hong 沈凤娇;罗典涛;沈友虎;宋明霞;胡长顺;朱源;陈静;毛安;熊冰烨;徐红(Shanghai Jinshan TCM-Integrated Hospital,Shanghai 201501,China;Jingdong Traditional Chinese Medicine Hospital,Yunnan Province,Pu’er 676200,China;Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]Shanghai Jinshan TCM-Integrated Hospital,Shanghai 201501,China [2]Jingdong Traditional Chinese Medicine Hospital,Yunnan Province,Pu’er 676200,China [3]Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China

出　　处：《Journal of Acupuncture and Tuina Science》2024年第6期503-513,共11页针灸推拿医学（英文版）

基　　金：上海市金山区卫生健康委员会专项科研课题,No.JSKJ-KTQN-2021-09;上海市卫生健康委员会中医专科培育项目.

摘　　要：Objective:To systematically assess the effectiveness and safety of acupuncture for spastic hemiplegia after ischemic stroke.Methods:Randomized controlled trials(RCTs)of acupuncture treatment for spastic hemiplegia after ischemic stroke meeting the inclusion criteria in Cochrane Library,Medline,Excerpta Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure(CNKI),SinoMed,Chongqing VIP Database(VIP),and Wanfang Data Knowledge Service Platform(Wanfang)published from each database’s inception to February 2023 were retrieved by computer.Two reviewers independently extracted data and evaluated the risk of bias using Cochrane’s risk of bias tool.Review Manager 5.4 was used for data analysis.Continuous data were evaluated using mean difference(MD)with a 95%confidence interval(CI),and dichotomous data were analyzed using risk ratio(RR).Results:A total of 24 trials,including 1970 participants,were included in the study.The meta-analysis of 7 trials showed that compared to the rehabilitation therapy,acupuncture therapy was more effective in improving the simplified Fugl-Meyer assessment score after 1-month treatments[MD=10.52,95%CI(7.81,13.23),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.18,95%CI(11.34,27.02),P<0.001],and the 6-month treatment course resulted in better outcomes than the 1-month course.The meta-analysis of 8 trials showed that acupuncture had a better improvement on the Barthel index score than rehabilitation therapy after 1-month treatments[MD=10.78,95%CI(8.91,12.64),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.94,95%CI(19.02,20.87),P<0.001],and the 6-month course was better than the 1-month course.The meta-analysis of 2 trials showed that the effective rate of the modified Ashworth scale score improvement was more notable in the acupuncture group after 1-month treatments[RR=1.20,95%CI(1.02,1.40),P=0.020].One trial reported no adverse event,and 1 trial reported 3 adverse events without目的:系统性评价针刺治疗缺血性中风后痉挛性偏瘫的疗效和安全性。方法:系统检索Cochrane Library、Medline、EMBASE、PubMed、中国知网(CNKI)、中国生物医学文献服务系统(SinoMed)、维普资讯中文期刊服务平台(VIP)、万方数据知识服务平台(Wanfang)从创建至2023年2月符合纳入标准的针刺治疗缺血性中风后痉挛性偏瘫的临床随机对照试验。由两名研究者独立提取数据并且根据Cochrane偏倚风险工具来评估偏倚风险。数据分析采用Revman 5.4软件。连续性资料采用均数差(MD)进行分析,置信区间(CI)取95%进行计算。二分类资料采用相对危险度(RR)进行分析。结果:包括1970名受试者的24篇文献被纳入研究。针对7篇文献的Meta分析显示,经过1个月的治疗后,针刺疗法相比康复疗法能更有效地提高简化Fugl-Meyer评定分值[MD=10.52,95%CI(7.81,13.23),P<0.001]。针对2篇文献的Meta分析显示,经过6个月治疗后,观察到同样的趋势(MD=19.18,95%CI(11.34,27.02),P<0.001),且6个月的疗效优于1个月的疗效。针对8篇文献的Meta分析显示,经过1个月的治疗后,针刺疗法对比康复疗法能更好地改善Barthel指数分值[MD=10.78,95%CI(8.91,12.64),P<0.001]。针对2篇文献的Meta分析显示,经过6个月的治疗后,观察到同样的趋势[MD=19.94,95%CI(19.02,20.87),P<0.001],且6个月的疗效优于1个月的疗效。针对2篇文献的Meta分析显示, 经过1个月的治疗后, 针刺疗法相比康复疗法能更好地提高基于改良Ashworth量表分值评估的治疗有效 率[RR=1.20, 95%CI(1.02, 1.40, P=0.020)]。有1篇文献报告未观察到任何不良反应;1篇文献报告了3例轻微的不良反 应。结论: 对于缺血性中风后痉挛性偏瘫, 针刺可能是一个有效且安全的方法, 但仍需要更多基于客观评价的高质 量、大样本的随机对照试验来增加结论的信服力。

关 键 词：Acupuncture therapy Hemiplegia Spastic Ischemic Stroke Poststroke Syndrome Meta Analysis Systematic Review 

分 类 号：R246.6[医药卫生—针灸推拿学]