Xie Yue, Wang Liping, He Jinghua, Wu Taixiang
Department of Acupuncture and Moxibustion, Huguosi Hospital of Traditional Chinese Medicine, No. 83 Cotton Hu Tong, Xi Cheng Qu, Beijing, China, 100035.
Cochrane Database Syst Rev. 2008 Jul 16(3):CD006076. doi: 10.1002/14651858.CD006076.pub2.
Dysphagia after acute stroke is associated with poor prognosis, particularly if prolonged. Acupuncture has been widely used for this complication in China. However, its therapeutic effect is unclear.
To determine the therapeutic effect of acupuncture for dysphagia after acute stroke compared with placebo, sham or no acupuncture intervention.
We searched the Cochrane Stroke Group Trials Register (last searched September 2007), the Chinese Stroke Trials Register and the Trials Register of the Cochrane Complementary Medicine Field (last searched January 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2007). In January 2007 we searched the following databases from the first available date; MEDLINE, EMBASE, CINAHL, AMED, CISCOM, BIOSIS Previews, ProQuest Digital Dissertations, Science Citation Index, ISI Proceedings, ACUBRIEFS, ACP Journal Club, Books@Ovid and Journals@Ovid, Chinese Biological Medicine Database, Chinese scientific periodical database of VIP INFORMATION, China periodical in China National Knowledge Infrastructure, Chinese Evidence-Based Medicine Database, Science China, Chinese Social Science Citation Index, and the Chinese Science and Technology Document Databases. We also searched databases of ongoing trials, conference proceedings, and grey literature, handsearched three Chinese journals and contacted authors and researchers.
We included all truly randomised controlled trials that evaluated the effect of acupuncture, irrespective of type, in patients with dysphagia within 30 day after the onset of ischaemic or haemorrhagic stroke. All types of acupuncture interventions were eligible. The control intervention could be placebo acupuncture, sham acupuncture, or no acupuncture. The primary outcome was recovery of normal feeding. The secondary outcomes were case fatality, deterioration, late disability, length of hospital stay, quality of life, feeding tube removal, aspiration pneumonia and nutritional measures.
Two review authors independently selected trials, assessed trial quality, and extracted data. Disagreements were resolved by a third review author.
Only one trial of 66 participants was included. In the acupuncture group, 12 out of 34 participants recovered to normal feeding (35.3%). In the control group, seven out of 32 participants recovered to normal feeding (21.9%). The relative risk of recovery was 1.61 with a 95% confidence interval of 0.73 to 3.58. No statistical significance was detected.
AUTHORS' CONCLUSIONS: There is not enough evidence to make any conclusion about the therapeutic effect of acupuncture for dysphagia after acute stroke. High quality and large scale randomised controlled trials are needed.
急性卒中后吞咽困难与预后不良相关，尤其是吞咽困难持续时间延长时。在中国，针灸已广泛用于治疗这种并发症。然而，其治疗效果尚不清楚。
确定与安慰剂、假针灸或无针灸干预相比，针灸治疗急性卒中后吞咽困难的疗效。
我们检索了Cochrane卒中组试验注册库（最后检索时间为2007年9月）、中国卒中试验注册库、Cochrane补充医学领域试验注册库（最后检索时间为2007年1月）以及Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》，2007年第2期）。2007年1月，我们从各数据库的最早可用日期开始检索以下数据库；医学索引（MEDLINE）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）、联合和补充医学数据库（AMED）、补充医学资源整合数据库（CISCOM）、生物学文摘数据库（BIOSIS Previews）、ProQuest博硕士论文数据库、科学引文索引、科技会议录索引、针灸文摘数据库（ACUBRIEFS）、内科学年鉴俱乐部（ACP Journal Club）、Ovid电子图书、Ovid电子期刊、中国生物医学文献数据库、维普中文科技期刊数据库、中国知网中国期刊全文数据库、中国循证医学数据库、《中国科学》、中国社会科学引文索引以及中国科技文献数据库。我们还检索了正在进行的试验数据库、会议论文集和灰色文献，手工检索了三种中文期刊，并联系了作者和研究人员。
我们纳入了所有评估针灸效果的真正随机对照试验，无论类型类型不限类型，研究对象为缺血性或出血性卒中发病30天内出现吞咽困难的患者。所有类型的针灸干预均符合条件。对照干预可以是安慰剂针灸、假针灸或无针灸。主要结局是恢复正常进食。次要结局包括病死率、病情恶化、晚期残疾、住院时间、生活质量、拔除鼻饲管、吸入性肺炎和营养指标。
两位综述作者独立选择试验、评估试验质量并提取数据。分歧由第三位综述作者解决。
仅纳入了一项有66名参与者的试验。针灸组34名参与者中有12名恢复正常进食（35.3%）。对照组32名参与者中有7名恢复正常进食（21.9%）。恢复的相对风险为1.61，95%置信区间为0.73至3.58。未检测到统计学显著性差异。
没有足够证据就针灸治疗急性卒中后吞咽困难的疗效得出任何结论。需要高质量、大规模的随机对照试验。
