针灸及相关疗法用于癌症姑息治疗中的症状管理：系统评价与荟萃分析
Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis.
作者信息
Lau Charlotte H Y, Wu Xinyin, Chung Vincent C H, Liu Xin, Hui Edwin P, Cramer Holger, Lauche Romy, Wong Samuel Y S, Lau Alexander Y L, Sit Regina W S, Ziea Eric T C, Ng Bacon F L, Wu Justin C Y
机构信息
From the Faculty of Medicine (CHL); Hong Kong Institute of Integrative Medicine (XW, VCC, EPH, SYW, AYL, RWSS, JCW); Jockey Club School of Public Health and Primary Care (XW, VCC, XL, SYW, RWSS); Comprehensive Cancer Trials Unit (EPH), The Chinese University of Hong Kong, Hong Kong, China; Department of Internal and Integrative Medicine (HC), Faculty of Medicine, Kliniken Essen-MitteUniversity of Duisburg-Essen, Essen, Germany; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM) (HC), Faculty of Health, University of Technology Sydney, Sydney, Australia; Department of Medicine and Therapeutics (AYL, JCW), The Chinese University of Hong Kong; and Chinese Medicine Department (ETZ, BFN), Hong Kong Hospital Authority, Hong Kong, China.
出版信息
Medicine (Baltimore). 2016 Mar;95(9):e2901. doi: 10.1097/MD.0000000000002901.
Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care. The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: -0.76, 95% confidence interval: -0.14 to -0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36-1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild. Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting future RCTs in these areas.
现有系统评价显示，针刺及相关疗法用于癌症姑息治疗的有效性尚不确定。本系统评价和荟萃分析的目的是总结针刺及相关疗法用于癌症姑息治疗的当前最佳证据。检索了5个国际数据库和3个中文数据库。纳入比较针刺及相关疗法与传统治疗或假治疗的随机对照试验（RCT）。主要结局包括疲劳、感觉异常和感觉障碍、慢性疼痛、厌食、失眠、肢体水肿、便秘以及健康相关生活质量，目前有效的传统干预措施有限。共纳入13项RCT。荟萃分析表明，与传统干预措施相比，针刺及相关疗法能显著减轻肝癌或胃癌患者的疼痛（2项研究，n = 175，合并加权平均差：-0.76，95%置信区间：-0.14至-0.39）。针刺及相关疗法与中药联合使用可改善胃肠道癌患者的生活质量（2项研究，n = 111，合并标准平均差：0.75，95%置信区间：0.36 - 1.13）。与假按压相比，指压在减轻肺癌患者疲劳方面显示出显著疗效。针刺及相关疗法的不良事件少见且轻微。与单纯传统干预相比，针刺及相关疗法在减轻癌症患者疼痛、疲劳以及改善生活质量方面有效。现有证据的局限性表明，它们应作为传统护理的补充，而非替代方法。针刺及相关疗法用于治疗癌症患者厌食、减轻便秘、感觉异常和感觉障碍、失眠以及肢体水肿的有效性尚不确定，需要在这些领域开展未来的RCT。
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