针刺治疗卒中后神经源性膀胱随机对照试验Meta分析及选穴规律研究  

Meta-Analysis and Study on Acupoint Selection Rules in a Randomized Controlled Trial of Acupuncture Treatment for Neurogenic Bladder after Stroke

作　　者：钱芳芸 顾兆军[1] 王栋[1] QIAN Fangyun;GU Zhaojun;WANG Dong(Jiangsu Second Hospital of Traditional Chinese Medicine,Nanjing 210017,Jiangsu,China)

机构地区：[1]江苏省第二中医院,江苏南京210017

出　　处：《辽宁中医药大学学报》2025年第5期130-136,共7页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家中医药管理局全国名老中医药专家顾兆军传承工作室建设项目(国中医药人教函[2022]75号);江苏省中医药管理局江苏省中医特色专科建设项目(苏中医综合[2023]2号)。

摘　　要：目的系统评价针刺治疗卒中后神经源性膀胱随机的临床疗效及选穴规律。方法检索中国知网、万方、维普、超星、Pubmed数据库中针刺治疗卒中后神经源性膀胱的随机对照试验(RCTs),检索时间为建库至2024年1月。对照组予以常规治疗,观察组运用针刺治疗,疗程不限。根据纳入与排除标准由两位研究者独立筛选文献,利用RevMan5.3系统评价软件对2组患者总有效率、排尿日记、尿动力学、生活质量评分(I-QOL)等指标进行Meta分析;收集纳入研究的针刺选穴处方,利用Excel分析针刺治疗卒中后神经源性膀胱的选穴规律。结果共纳入13篇RCTs文献,涉及983例患者。Meta分析结果显示,与对照组比较,针刺治疗后患者24 h排尿数[MD(95%CI)=-1.93(-3.03~-0.82),Z=3.41,P<0.001]、24 h尿失禁数[MD(95%CI)=-0.96(-1.44~0.47),Z=3.87,P<0.001]均明显更低,单次平均排尿量[MD(95%CI)=35.36(18.48~52.24),Z=4.11,P<0.001]明显更高;与对照组比较,针刺治疗后患者最大膀胱容量[MD(95%CI)=39.70(27.05~52.35),Z=6.15,P<0.001]明显更高,膀胱残余尿量[MD(95%CI)=-28.22(-36.76~-19.69),Z=6.48,P<0.001]明显更低,最大尿流率[MD(95%CI)=3.70(1.73~5.68),Z=3.67,P<0.001]明显更快;与对照组比较,针刺治疗后患者I-QOL评分[SMD(95%CI)=1.73(0.42~3.05),Z=2.58,P=0.01]明显更高,并在提高临床疗效[OR(95%CI)=4.00(2.72~5.88),Z=7.06,P<0.001]方面更有优势。纳入研究的13个腧穴处方共涉及腧穴21个,阿是穴2个,腧穴总使用频次为71次,使用频次最高的腧穴为次髎,其次为膀胱俞、上髎、肾俞等穴位,主要集中在足太阳膀胱经,其次为任脉、督脉。结论针刺可以有效改善卒中后神经源性膀胱患者排尿情况、尿动力学、生活质量等指标,并明显提高临床疗效;选穴以足太阳膀胱经所属腧穴为主,其中八髎穴最多。但部分研究设计不规范,下一步需开展多中心、大样本的高质量临床随机对照研究,为针刺治疗卒中后神经源�Objective To systematically evaluate the clinical efficacy and acupoint selection rules of acupuncture treatment for neurogenic bladder after stroke.Methods Randomized controlled trials(RCTs)of acupuncture treatment for neurogenic bladder after stroke were retrieved from databases such as CNKI,WanFang,VIP,Chaoxing and Pubmed.The retrieval period was from the establishment of the database to January 2024.The control group received routine treatment,while the observation group received acupuncture treatment,with an unlimited course of treatment.According to the inclusion and exclusion criteria,two researchers independently screened the literature and used the RevMan5.3 system evaluation software to conduct Meta-analysis on indicators such as total effective rate,urinary diary,urodynamics and quality of life score(I-QOL)in both groups of patients,collect acupuncture point selection prescriptions included in the study,and use Excel to analyze the selection rules of acupuncture treatment for neurogenic bladder after stroke.Results A total of 13 RCTs articles were included,involving 983 patients.The Meta-analysis results showed that compared with the control group,the patients with acupuncture treatment had significantly lower 24 hour urination count[MD(95%CI)=1.93(-3.03--0.82),Z=3.41,P<0.001],24 hour urinary incontinence count[MD(95%CI)=-0.96(-1.44-0.47),Z=3.87,P<0.001],and significantly higher average single urination volume[MD(95%CI)=35.36(18.48-52.24),Z=4.11,P<0.001].Compared with the control group,after acupuncture treatment,the maximum bladder capacity[MD(95%CI)=39.70(27.05-52.35),Z=6.15,P<0.001]of patients was significantly higher,and the residual urine volume[MD(95%CI)=-28.22(-36.76--19.69),Z=6.48,P<0.001]was significantly lower.The maximum urine flow rate[MD(95%CI)=3.70(1.73-5.68),Z=3.67,P<0.001]was significantly faster.Compared with the control group,the patients with acupuncture treatment had significantly higher I-QOL scores[SMD(95%CI)=1.73(0.42-3.05),Z=2.58,P=0.01],and an advantage in improving clinical ef

关 键 词：卒中 神经源性膀胱 针刺 电针 随机对照试验 选穴规律 次髎穴 排尿日记 尿动力学 生活质量 系统评价 Meta分析 

分 类 号：R255.2[医药卫生—中医内科学]