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电针治疗中风后反射性交感神经营养不良:一项荟萃分析。

Electroacupuncture for Reflex Sympathetic Dystrophy after Stroke: A Meta-Analysis.

作者信息

Wei Xuqiang, He Liyun, Liu Jia, Ai Yanke, Liu Yali, Yang Yi, Liu Baoyan

机构信息

College of Acupuncture and Orthopedic, Hubei University of Traditional Chinese Medicine, Wuhan, Hubei, P.R. China; Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, P.R. China.

Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, P.R. China.

出版信息

J Stroke Cerebrovasc Dis. 2019 May;28(5):1388-1399. doi: 10.1016/j.jstrokecerebrovasdis.2019.02.010. Epub 2019 Feb 28.

Abstract

BACKGROUND

Reflex sympathetic dystrophy (RSD) is the common complication among stroke and cerebral injury patients, which is lack of safe and effective treatment. Electroacupuncture (EA) may potentially be a reliably therapy, but the evidence is insufficiency.

METHODS

Cochrane Library, MEDLINE, Embase, Chinese National Knowledge Infrastructure, Wan Fang Data, the Chinese Biology Medicine disc, etc., were searched, until July 20, 2018. We included random control trials that contrast EA with conventional rehabilitation therapy for the treatment of RSD. Main outcomes were visual analog scale score and Fugl-Meyer upper limb motor function scoring scale, other outcomes such as Barthel index, and hand swelling score were also collected. Data in included studies were extracted into an excel and pooled by Stata/MP 14.1.

RESULTS

We incorporated 13 studies involving 1040 RSD patients and outcomes were from 2 to 6 weeks' follow-up. The analgesic effect between 2 groups had statistically significant difference (weighted mean difference [WMD] = -1.122, 95% confidence interval [CI] [-1.682 to -.562], P = .000], a statistical difference existed in improving dysfunction between 2 groups: (WMD = 6.039, 95% CI [2.231-.916], P = .000). EA groups had a better effect on improving activities of daily life abilities (WMD = 12.170, 95% CI [6.657-17.682], P < .00011] and better detumescence effect (WMD = -.800, 95% CI [-1.972 to -.212], P = .000] contrast to conventional rehabilitation therapy.

CONCLUSIONS

This meta-analysis supports that EA has a positive effect on alleviating pain, improving limb dysfunction, and promoting activities of daily living. On account of moderate-quality random control trials and high heterogeneity, further high-quality studies are imperative to optimize the EA treatment program.

摘要

背景

反射性交感神经营养不良(RSD)是中风和脑损伤患者的常见并发症,目前缺乏安全有效的治疗方法。电针(EA)可能是一种可靠的治疗方法,但证据不足。

方法

检索Cochrane图书馆、MEDLINE、Embase、中国知网、万方数据、中国生物医学光盘等,检索截至2018年7月20日。我们纳入了将电针与传统康复治疗对比治疗RSD的随机对照试验。主要结局指标为视觉模拟量表评分和Fugl-Meyer上肢运动功能评分量表,还收集了其他结局指标,如Barthel指数和手部肿胀评分。将纳入研究的数据提取到Excel中,并用Stata/MP 14.1进行汇总。

结果

我们纳入了13项研究,涉及1040例RSD患者,结局为2至6周的随访结果。两组间镇痛效果有统计学显著差异(加权均数差[WMD]=-1.122,95%置信区间[CI][-1.682至-0.562],P = 0.000),两组间改善功能障碍存在统计学差异:(WMD = 6.039,95% CI [2.231至9.16],P = 0.000)。与传统康复治疗相比,电针组在改善日常生活能力方面效果更好(WMD = 12.170,95% CI [6.657至17.682],P < 0.000],消肿效果更好(WMD = -0.800,95% CI [-1.972至-0.212],P = 0.000)。

结论

本荟萃分析支持电针在缓解疼痛、改善肢体功能障碍和促进日常生活活动方面具有积极作用。鉴于中等质量的随机对照试验和高异质性,迫切需要进一步开展高质量研究以优化电针治疗方案。

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