Wang Li-ping, Xie Yue
Huguosi Hospital of TCM Affiliated to Beijing University of TCM, Beijing 100035, China.
Zhongguo Zhen Jiu. 2006 Feb;26(2):141-6.
To assess the therapeutic effect and potential adverse effect of acupuncture in treatment of dysphagia after stroke.
A systematic review including all the relevant randomized controlled trials (RCTs) or quasi-RCTs of acupuncture and moxibustion for treatment of dysphagia after stroke were performed using the method recommended by the cochrane collaboration.
Seven papers including 506 cases met the enrolled criteria. All of the trials were of lower methodological quality. Meta-analysis of enrolled 6 trials showed that the acupuncture group had a better therapeutic effect on dysphagia after stroke than the control group (RR 1.17, 95% CI 1.08, 1.27, Z=3.78, P=0.0002). The mortality and the occurrence of pneumonia were similar between acupuncture and control groups (RR 0.25, 95% CI 0.03, 2.18 and RR 3.02, 95% CI 0.093, 23.10, respectively). The treatment group significantly reduced in time of the thick barium through pharynx examined by videofluorography (WMD -7.23, 95% CI -13.18,-1.28).
A reliable conclusion can not be drawn from the present data because of the defects in methodological quality, especially no long-term terminal outcome events, although it appears a tendency that acupuncture can improve dysphagia after stroke in short-term with no adverse effect. Therefore, it is necessary to perform more multi central randomized controlled trials in good internal validity and high quality in future.
评估针刺治疗中风后吞咽困难的疗效及潜在不良反应。
按照Cochrane协作网推荐的方法,对针刺和艾灸治疗中风后吞咽困难的所有相关随机对照试验(RCT)或半随机对照试验进行系统评价。
7篇文献共506例符合纳入标准。所有试验的方法学质量较低。纳入的6项试验的Meta分析显示,针刺组治疗中风后吞咽困难的疗效优于对照组(RR 1.17,95%CI 1.08,1.27,Z=3.78,P=0.0002)。针刺组与对照组的死亡率和肺炎发生率相似(RR分别为0.25,95%CI 0.03,2.18和RR 3.02,95%CI 0.093,23.10)。治疗组经电视荧光吞咽造影检查的浓稠钡剂通过咽部的时间显著缩短(WMD -7.23,95%CI -13.18,-1.28)。
由于方法学质量存在缺陷,尤其是缺乏长期终点事件,目前的数据无法得出可靠结论,尽管针刺似乎有在短期内改善中风后吞咽困难且无不良反应的趋势。因此,未来有必要开展更多具有良好内部效度和高质量的多中心随机对照试验。