Cai Yiyi, Zhang Claire Shuiqing, Liu Shaonan, Wen Zehuai, Zhang Anthony Lin, Guo Xinfeng, Lu Chuanjian, Xue Charlie Changli
China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia; Guangdong Provincial Hospital of Chinese Medicine (The Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia.
Arch Phys Med Rehabil. 2017 Dec;98(12):2578-2589.e4. doi: 10.1016/j.apmr.2017.03.023. Epub 2017 Apr 25.
To evaluate the effects and safety of electroacupuncture (EA) for stroke patients with spasticity.
Five English databases (PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database) and 4 Chinese databases (Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Chongqing VIP Database, Wanfang Database) were searched from their inception to September 2016.
Randomized controlled trials were included if they measured spasticity with the Modified Ashworth Scale (MAS) in stroke patients and investigated the add-on effects of electroacupuncture to routine pharmacotherapy and rehabilitation therapies.
Information on patients, study design, treatment details and outcomes assessing spasticity severity, motor function, and activities of daily living was extracted.
In total, 22 trials involving 1425 participants met the search criteria and were included. The estimated add-on effects of EA to reduce spasticity in the upper limbs as measured by the MAS (standardized mean difference [SMD]=-.57; 95% confidence interval [CI], -.84 to -.29), and to improve overall motor function as measured by the Fugl-Meyer Assessment of Sensorimotor Recovery (mean difference [MD]=10.60; 95% CI, 8.67-12.53) were significant. Significant add-on effects of EA were also shown for spasticity in the lower limbs, lower-limb motor function, and activities of daily living ([SMD=-.88; 95% CI, -1.42 to -.35;], [MD=4.42; 95% CI, .06-8.78], and [MD=6.85; 95% CI, 3.64-10.05], respectively), although with high heterogeneity. For upper-limb motor function, no significant add-on effects of EA were found.
EA combined with conventional routine care has the potential of reducing spasticity in the upper and lower limbs and improving overall and lower extremity motor function and activities of daily living for patients with spasticity, within 180 days poststroke. Further studies of high methodological and reporting quality are needed to confirm the effects and safety of EA, and to explore the adequate and optimal protocol of EA for poststroke spasticity, incorporating a group of comprehensive outcome measures in different populations.
评估电针对中风后痉挛患者的疗效及安全性。
检索了5个英文数据库（PubMed、EMBASE、CINAHL、Cochrane对照试验中央注册库、联合与补充医学数据库）以及4个中文数据库（中国生物医学文献数据库、中国知网、维普数据库、万方数据库），检索时间从建库至2016年9月。
纳入的随机对照试验需满足以下条件：采用改良Ashworth量表（MAS）评估中风患者的痉挛程度，并研究电针联合常规药物治疗及康复治疗的附加效果。
提取患者信息、研究设计、治疗细节以及评估痉挛严重程度、运动功能和日常生活活动能力的结局指标。
共有22项试验、1425名参与者符合检索标准并被纳入。电针在降低上肢痉挛方面的附加效果显著（以MAS评估，标准化均数差[SMD]= -0.57；95%置信区间[CI]，-0.84至-0.29），在改善整体运动功能方面（以Fugl-Meyer运动功能评定量表评估，均数差[MD]=10.60；95%CI，8.67 - 12.53）也有显著效果。电针在降低下肢痉挛、改善下肢运动功能和日常生活活动能力方面同样显示出显著的附加效果（[SMD = -0.88；95%CI，-1.42至-0.35]、[MD = 4.42；95%CI，0.06 - 8.78]以及[MD = 6.85；95%CI，3.64 - 10.05]），尽管存在高度异质性。在上肢运动功能方面，未发现电针有显著的附加效果。
电针联合传统常规护理有可能在中风后180天内减轻痉挛患者的上肢和下肢痉挛程度，改善整体及下肢运动功能和日常生活活动能力。需要进一步开展方法学和报告质量较高的研究来证实电针的疗效和安全性，并探索针对中风后痉挛的合适且最佳的电针方案，纳入不同人群的一组综合结局指标。
