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婴儿抚触治疗婴儿功能性便秘临床疗效的 Meta 分析。

Clinical Efficacy of Infantile Massage in the Treatment of Infant Functional Constipation: A Meta-Analysis.

机构信息

School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.

State Key Laboratory of Precision Measuring Technology and Instruments, Tianjin University, Tianjin, China.

出版信息

Front Public Health. 2021 Jun 11;9:663581. doi: 10.3389/fpubh.2021.663581. eCollection 2021.


DOI:10.3389/fpubh.2021.663581
PMID:34178921
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8232057/
Abstract

Functional constipation in children is a common disease that causes a psychological burden on infants and young children across the world. It will greatly affect infant quality of life in early childhood and even affect their psychological and physical health. At present, infant functional constipation is treated with western drugs alone, but this can produce drug dependency. In recent years, Traditional Chinese Medicine (TCM) infant massage has been used as a complementary and alternative therapy, and its effectiveness and safety have been proven, attracting the attention of numerous researchers. Our study aimed to compare the influence of infant massage intervention on defecation frequency and consistency, determine the effectiveness, and safety of infant massage in the treatment of infant functional constipation, and obtain high-quality clinical evidence. Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, inclusion, and exclusion criteria were formulated. Randomized controlled trials (RCTs) on TCM infant massage for the treatment of infant functional constipation were found following a search of four mainstream medical databases. RCTs found to meet the study's requirement were included; data information was then extracted, and the quality was assessed using the Cochrane bias risk assessment tool. Through RevMan software, a meta-analysis was carried out for overall effective rate, stool form, defecation frequency, defecation difficulty, and constipation symptom scoring index. The relative risk (RR) and 95% confidence interval (95% CI) were calculated, heterogeneity was tested and its source was found, and publication bias was assessed through the Egger's and Begg's tests and by means of funnel plots. A total of 23 RCTs and 2,005 patients were included. The results of the meta-analysis showed that compared to drug therapy alone, TCM infant massage had a superior effect on the treatment of infant functional constipation. This difference was statistically significant ( < 0.05) and evaluated according to the overall effective rate (RR = 1.25; 95% CI = 1.17, 1.33), defecation frequency [mean difference (MD) = -0.72; 95% CI = -0.80, -0.65], and constipation symptom score (MD = -0.81; 95% CI = -1.20, -0.43), showing that TCM infant massage is indeed superior to drug therapy alone in the treatment of infant functional constipation. TCM infant massage was found to be equivalent to drug therapy alone in terms of the stool form score [-0.30 (-0.38, -0.22)] and the defecation difficulty score [-0.73 (-0.81, -0.65)], since the difference was not statistically significant ( > 0.05). The source of heterogeneity might be related to the state of patient, manipulation of the massages, efficacy of drugs in the control group, and difference in judgment criteria for efficacy. The Egger's test and Begg's test showed that publication bias did not occur in our study. TCM infant massage can increase defecation frequency and reduce the symptoms of constipation in children suffering from functional constipation; in addition, the clinical trial showed beneficial effects. Since some of the RCTs featured a very small sample size, the reliability and validity of our study's conclusion may have been affected as well; therefore, the explanation should be treated with some caution. In the future, a large number of higher-quality RCTs are still needed to confirm the results of our study.

摘要

儿童功能性便秘是一种常见疾病,会给全世界的婴幼儿带来心理负担。它会极大地影响婴幼儿的生活质量,甚至影响他们的心理和身体健康。目前,儿童功能性便秘仅采用西药治疗,但这可能会产生药物依赖性。近年来,中医婴儿按摩已作为一种补充和替代疗法,其疗效和安全性已得到证实,引起了众多研究人员的关注。

我们的研究旨在比较婴儿按摩干预对排便频率和一致性的影响,确定婴儿按摩治疗儿童功能性便秘的有效性和安全性,并获得高质量的临床证据。

基于系统评价和荟萃分析的首选报告项目(PRISMA)声明,制定了纳入和排除标准。通过搜索四个主流医学数据库,发现了关于中医婴儿按摩治疗儿童功能性便秘的随机对照试验(RCT)。纳入符合研究要求的 RCT;然后提取数据信息,并使用 Cochrane 偏倚风险评估工具评估质量。通过 RevMan 软件对总有效率、粪便形态、排便频率、排便困难和便秘症状评分指数进行荟萃分析。计算相对风险(RR)和 95%置信区间(95%CI),检验异质性并找出其来源,并通过 Egger 检验和 Begg 检验以及漏斗图评估发表偏倚。

共纳入 23 项 RCT 和 2005 例患者。荟萃分析结果表明,与单独药物治疗相比,中医婴儿按摩在治疗儿童功能性便秘方面效果更好。这种差异具有统计学意义(<0.05),并根据总有效率(RR=1.25;95%CI=1.17,1.33)、排便频率[均数差(MD)=-0.72;95%CI=-0.80,-0.65]和便秘症状评分(MD=-0.81;95%CI=-1.20,-0.43)进行评估,表明中医婴儿按摩在治疗儿童功能性便秘方面确实优于单独药物治疗。中医婴儿按摩在粪便形态评分[MD=-0.30(-0.38,-0.22)]和排便困难评分[MD=-0.73(-0.81,-0.65)]方面与单独药物治疗相当,因为差异无统计学意义(>0.05)。异质性的来源可能与患者的状态、按摩的操作、对照组药物的疗效以及疗效判断标准的差异有关。Egger 检验和 Begg 检验表明,我们的研究未发生发表偏倚。

中医婴儿按摩可以增加儿童功能性便秘的排便频率,减轻便秘症状;此外,临床试验显示出有益的效果。由于一些 RCT 样本量很小,因此我们研究结论的可靠性和有效性可能受到影响;因此,对该解释应持谨慎态度。未来仍需要大量高质量的 RCT 来证实我们的研究结果。

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