三种针灸方法治疗混合痔术后疼痛的疗效比较：系统评价和网络Meta 分析。
Three Acupuncture Methods for Postoperative Pain in Mixed Hemorrhoids: A Systematic Review and Network Meta-Analysis.
机构信息
Department of Anorectology, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University, Wenzhou 325000, China.
Department of Traditional Chinese Medicine, Shanghai Eighth People's Hospital, Shanghai 200235, China.
出版信息
Comput Math Methods Med. 2022 Sep 26;2022:5627550. doi: 10.1155/2022/5627550. eCollection 2022.
BACKGROUND
Mixed hemorrhoids are a common anorectal disorder, surgery is the most effective means of eradicating hemorrhoids, and pain is the most common postoperative complication of mixed hemorrhoids.
OBJECTIVE
To compare the clinical efficacy of auricular plaster, acupoint application, and acupoint catgut embedding for treating postoperative pain in mixed hemorrhoids.
METHOD
PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM databases were searched for randomized controlled trials (RCTs) of three acupuncture-related therapies for postoperative pain in mixed hemorrhoids from the time of database creation to October 2021. After screening the literature, extracting information, and evaluating the risk of bias of included studies, statistical analysis was performed using RevMan 5.3 and Stata 15.0.
RESULT
Forty-seven RCTs with a total of 5121 patients were included. Network meta-analysis (NMA) showed that auricular plaster (OR = 5.90, 95% CI = (2.02, 17.21)) and acupoint catgut embedding therapy (OR = 5.55, 95% CI = (1.01, 30.40)) were more effective than analgesics in the treatment of postoperative pain in mixed hemorrhoids. The cumulative ranking probability (SUCRA) showed that acupoint application (73.6%) had the best overall efficacy and the rest were auricular plaster (68.7%), acupoint catgut embedding therapy (64.6%), auricular plaster combined with acupoint application (63.4%), and pain medication (8.9%) in that order. Secondly, auricular plaster (OR = -0.93, 95% CI = (-1.66, -0.20)), acupoint catgut embedding (OR = -0.8, 95% CI = (-1.50, -0.10)), and acupoint application (OR = -1.4, 95% CI = (-2.50, -0.31)) all led to a significant decrease in pain scores and were all more effective than analgesics. As ranked by SUCRA, the results showed that the efficacy of acupoint application (73.5%) was optimal and the rest were auricular plaster (56.1%), acupoint catgut embedding (50.2%), and pain medication (15.3%) in that order. In terms of pain degree, acupoint application (OR = 3.83, 95% CI = (1.25, 11.74)) was significantly better than pain medication.
CONCLUSION
Acupoint application can improve the overall efficiency, reduce pain scores, and relieve the degree of postoperative pain in mixed hemorrhoids.
背景
混合痔是一种常见的肛肠疾病，手术是根除痔的最有效手段，而疼痛是混合痔术后最常见的并发症。
目的
比较耳贴、穴位敷贴和穴位埋线治疗混合痔术后疼痛的临床疗效。
方法
计算机检索 PubMed、Embase、The Cochrane Library、Web of Science、中国知网、万方、维普及中国生物医学文献数据库，搜集关于耳贴、穴位敷贴和穴位埋线治疗混合痔术后疼痛的随机对照试验，检索时限均为建库至 2021 年 10 月。对纳入的文献进行筛选、资料提取和偏倚风险评价后，采用 RevMan 5.3 和 Stata 15.0 软件进行统计分析。
结果
共纳入 47 项 RCT，包含 5121 例患者。网状 Meta 分析结果显示，耳贴（OR =5.90，95%CI =（2.02，17.21））和穴位埋线疗法（OR =5.55，95%CI =（1.01，30.40））在治疗混合痔术后疼痛方面优于镇痛药物。累积排序概率（SUCRA）显示，穴位敷贴（73.6%）的总体疗效最佳，其次是耳贴（68.7%）、穴位埋线疗法（64.6%）、耳贴联合穴位敷贴（63.4%）和镇痛药物（8.9%）。其次，耳贴（OR =-0.93，95%CI =（-1.66，-0.20））、穴位埋线（OR =-0.80，95%CI =（-1.50，-0.10））和穴位敷贴（OR =-1.40，95%CI =（-2.50，-0.31））均能显著降低疼痛评分，且均优于镇痛药物。按照 SUCRA 排序，结果显示穴位敷贴（73.5%）的疗效最佳，其次是耳贴（56.1%）、穴位埋线疗法（50.2%）和镇痛药物（15.3%）。在疼痛程度方面，穴位敷贴（OR =3.83，95%CI =（1.25，11.74））显著优于镇痛药物。
结论
穴位敷贴可以提高混合痔术后的总体疗效，降低疼痛评分，缓解疼痛程度。
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