耳针对术前焦虑的影响：一项随机对照临床试验的系统评价和荟萃分析。

Auricular stimulation for preoperative anxiety - A systematic review and meta-analysis of randomized controlled clinical trials.

机构信息

Department of Anesthesiology, University Medicine of Greifswald, Germany; Department of Anesthesia, McMaster University, Hamilton, Canada.

Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine, Berlin, Germany.

出版信息

J Clin Anesth. 2022 Feb;76:110581. doi: 10.1016/j.jclinane.2021.110581. Epub 2021 Nov 12.

DOI:10.1016/j.jclinane.2021.110581

PMID:34781116

Abstract

STUDY OBJECTIVE: Previous randomized controlled trials (RCTs) suggest that auricular stimulation (AS) is safe and effective in treatment of preoperative anxiety; however, a systematic evaluation is lacking. The aim was to summarize the evidence on efficacy and safety of AS for preoperative anxiety, as well as for other outcomes. DESIGN: We conducted a systematic review of RCTs including patients from all available populations. The search was done through MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and Scopus Database from inception to June 2020. Study selection and data extraction were performed in by 2 independent reviewers with ability to resolve disagreements by a third author. Meta-analyses as well as the risk of bias and evidence quality assessments were performed according to the Cochrane 6.2, 2021 handbook recommendations. INTERVENTIONS: We compared AS with pharmacological and non-pharmacological interventions for different outcomes. MEASUREMENTS: We assessed the repercussion of the evaluated interventions over anxiety scores and their safety, physiological parameters, perioperative medications requirement and intensity of postoperative pain. MAIN RESULTS: We have included 15 studies with 1603 patients. AS has presented reduced anxiety scores as compared to the sham control (Standardized Mean Difference (SMD) -0.72, 95% confidence interval (CI) -1.09 to -0.36, p < 0.0001; 8 trials; 701 patients; heterogeneity: I 80%; GRADE: moderate certainty) and to no intervention (SMD -1.01, 95% CI -1.58 to -0.45, p = 0.0004; 4 trials; 420 patients; heterogeneity: I 84%; GRADE: very low certainty). There was no difference between AS and benzodiazepines (SMD -0.03; 95% CI: -0.34 to 0.28; p = 0.84; 3 trials; 158 patients; heterogeneity: I 0%; GRADE: very low certainty). No trials reported serious adverse effects of AS. CONCLUSIONS: AS may be useful in treatment of preoperative anxiety. Due to heterogenous certainty in effect estimates, further research is needed to clarify the actual efficacy of AS for preoperative anxiety.

摘要

研究目的：先前的随机对照试验（RCT）表明，耳穴刺激（AS）在治疗术前焦虑症方面是安全且有效的；然而，目前缺乏系统评价。本研究旨在总结 AS 治疗术前焦虑症以及其他结局的疗效和安全性证据。

设计：我们对 RCT 进行了系统评价，纳入了来自所有可利用人群的患者。通过 MEDLINE（PubMed）、EMBASE、Cochrane 对照试验中心注册库（CENTRAL）、ISI Web of Science 和 Scopus 数据库进行了检索，检索时间从建库至 2020 年 6 月。由 2 名具有解决分歧能力的独立审查员进行研究选择和数据提取，如果有分歧，则由第 3 名作者进行裁决。根据 Cochrane 6.2 手册和 2021 年推荐标准，进行了荟萃分析以及偏倚风险和证据质量评估。

干预措施：我们比较了 AS 与药物和非药物干预措施对不同结局的影响。

测量指标：我们评估了评估干预措施对焦虑评分及其安全性、生理参数、围手术期药物需求和术后疼痛强度的影响。

主要结果：我们纳入了 15 项研究，共 1603 名患者。与假对照相比，AS 降低了焦虑评分（标准化均数差（SMD）-0.72，95%置信区间（CI）-1.09 至-0.36，p<0.0001；8 项试验；701 名患者；异质性：I 80%；GRADE：中等确定性）和无干预（SMD-1.01，95%CI-1.58 至-0.45，p=0.0004；4 项试验；420 名患者；异质性：I 84%；GRADE：极低确定性）。AS 与苯二氮䓬类药物（SMD-0.03；95%CI：-0.34 至 0.28；p=0.84；3 项试验；158 名患者；异质性：I 0%；GRADE：极低确定性）之间无差异。没有试验报告 AS 的严重不良事件。

结论：AS 可能对治疗术前焦虑症有效。由于效应估计的确定性存在异质性，需要进一步研究来明确 AS 治疗术前焦虑症的实际疗效。