Jiang Hailun, Zhang Qiang, Zhao Qi, Chen Hao, Nan Xi, Liu Miao, Yin Chunsheng, Liu Wei, Fan Xiaonong, Meng Zhihong, Du Yuzheng
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China.
Evid Based Complement Alternat Med. 2022 Oct 15;2022:8803507. doi: 10.1155/2022/8803507. eCollection 2022.
. Poststroke dysphagia is one of the most common stroke complications with high morbidity and long course, while acupuncture treatment is easily accepted by patients due to its reliability, feasibility, simple operation, low price, and quick effect. Our objective was to evaluate the efficacy of manual acupuncture in poststroke dysphagia patients. . Databases including Medline, Web of Science, PubMed, Cochrane Library databases, EMBASE, CNKI (China National Knowledge Infrastructure), WanFang (WanFang Database), and VIP (Chongqing VIP) were searched from inception until Aug 19, 2022. Data were analyzed using Revman 5.3, Stata 14.0, and TSA 0.9.5.10 Beta software. Evidence quality evaluation was performed by using GRADE profiler 3.6. . A total of 33 randomized control trials (RCTs) enrolled 2680 patients. Meta-analysis results revealed that compared to rehabilitation, acupuncture decreased water swallow test (WST) and standard swallowing assessment (SSA) scores. Meanwhile, in contrast to rehabilitation alone, integration of acupuncture with rehabilitation effectively decreased WST and SSA scores; improved swallowing scores of videofluoroscopic swallowing study (VFSS), swallowing scores of Fujishima Ichiro, Barthel index (BI), and swallowing quality of life questionnaire (SWAL-QOL); reduced the aspiration rates as well as aspiration pneumonia; and shortened the duration of empty swallowing and the duration of 5 mL water swallowing. Pooled analysis did not reveal any significant differences in dysphagia outcome severity scores (DOSS) (=0.15 > 0.05) between the acupuncture group combined with rehabilitation group and the rehabilitation group alone. After the risk-of-bias assessment, these studies were not of low quality, except in terms of allocation concealment and blindness. Evidence quality evaluation showed that allocation concealment and blindness led to a downgrade and primary outcomes' evaluation of acupuncture combined with rehabilitation were ranked as moderate-quality evidence while acupuncture alone was ranked as low-quality. . This meta-analysis provided positive pieces of evidences that acupuncture and acupuncture combined with rehabilitation were better than using rehabilitation alone in the treatment of poststroke dysphagia.
脑卒中后吞咽困难是最常见的脑卒中并发症之一，发病率高且病程长，而针灸治疗因其可靠性、可行性、操作简单、价格低廉且疗效迅速而容易被患者接受。我们的目的是评估手针治疗脑卒中后吞咽困难患者的疗效。检索了包括Medline、Web of Science、PubMed、Cochrane图书馆数据库、EMBASE、中国知网（CNKI）、万方数据库和维普数据库（VIP）在内的数据库，检索时间从建库至2022年8月19日。使用Revman 5.3、Stata 14.0和TSA 0.9.5.10 Beta软件进行数据分析。采用GRADE profiler 3.6进行证据质量评估。共有33项随机对照试验（RCT）纳入了2680例患者。荟萃分析结果显示，与康复治疗相比，针灸降低了水吞咽试验（WST）和标准吞咽评估（SSA）评分。同时，与单纯康复治疗相比，针灸与康复治疗相结合有效降低了WST和SSA评分；提高了电视荧光吞咽造影检查（VFSS）的吞咽评分、藤岛一郎吞咽评分、巴氏指数（BI）以及吞咽生活质量问卷（SWAL-QOL）；降低了误吸率以及误吸性肺炎；缩短了空吞咽持续时间和5毫升水吞咽持续时间。汇总分析未显示针灸联合康复治疗组与单纯康复治疗组在吞咽困难结局严重程度评分（DOSS）方面有任何显著差异（=0.15>0.05）。在进行偏倚风险评估后，除分配隐藏和盲法方面外，这些研究质量并不低。证据质量评估表明，分配隐藏和盲法导致证据降级，针灸联合康复治疗的主要结局评估被列为中等质量证据，而单纯针灸则被列为低质量证据。这项荟萃分析提供了积极的证据，表明针灸以及针灸与康复治疗相结合在治疗脑卒中后吞咽困难方面优于单纯使用康复治疗。
