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针刺治疗急性肾绞痛的反应及完全缓解疼痛时间:一项随机对照试验的二次分析

Acupuncture for response and complete pain relief time of acute renal colic: Secondary analysis of a randomized controlled trial.

作者信息

Wang Xue-Zhou, Liu Cun-Zhi, Wang Li-Qiong, Qu Zhi-Cheng, Cao Ying, Yan Shi-Yan, Yang Jing-Wen, Tu Jian-Feng

机构信息

International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.

Emergency Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.

出版信息

Integr Med Res. 2024 Mar;13(1):101021. doi: 10.1016/j.imr.2024.101021. Epub 2024 Jan 20.

Abstract

BACKGROUND

The integration of acupuncture with intramuscular injection of diclofenac sodium can expedite the onset of analgesia in treating acute renal colic caused by urolithiasis. However, it remains unclear whether acupuncture can accelerate pain relief constantly until complete remission. This study aimed to explore the extent to which acupuncture can expedite the onset time of response or complete pain relief in treating acute renal colic, and the predictive value of patient characteristics for treatment efficacy.

METHODS

This secondary analysis utilized data from a prior randomized controlled trial. Eighty patients with acute renal colic were randomly assigned 1:1 to the acupuncture group or the sham acupuncture group. After intramuscular injection of diclofenac sodium, acupuncture or sham acupuncture was delivered to patients. The outcomes included time to response (at least a 50 % reduction in pain) and complete pain relief. Between-group comparison under the 2 events was estimated by Kaplan-Meier methodology. Subgroup analysis was performed utilizing the Cox proportional hazards model.

RESULTS

The median response time and complete pain relief time in the acupuncture group were lower than those in the sham acupuncture group (5 vs 30 min, Log Rank < 0.001; 20 min vs not observed, Log Rank < 0.001, respectively). Hazard Ratios (HRs) for response across all subgroups favored the acupuncture group. All HRs for complete pain relief favored acupuncture, expect large stone and moderate pain at baseline. No interaction was found in either event.

CONCLUSION

Acupuncture can accelerate the response time and complete pain relief time for patients with acute renal colic, with the efficacy universally.

TRIAL REGISTRATION

This study has been registered at Chinese Clinical Trial Registry: ChiCTR1900025202.

摘要

背景

针刺与肌肉注射双氯芬酸钠相结合可加快治疗尿路结石所致急性肾绞痛时镇痛作用的起效时间。然而,针刺是否能持续加速疼痛缓解直至完全缓解尚不清楚。本研究旨在探讨针刺在治疗急性肾绞痛时可加快反应起效时间或完全缓解疼痛的程度,以及患者特征对治疗效果的预测价值。

方法

本二次分析使用了一项既往随机对照试验的数据。80例急性肾绞痛患者按1:1随机分配至针刺组或假针刺组。在肌肉注射双氯芬酸钠后,对患者进行针刺或假针刺。观察指标包括反应时间(疼痛至少减轻50%)和完全缓解疼痛。采用Kaplan-Meier方法对这两个事件进行组间比较。利用Cox比例风险模型进行亚组分析。

结果

针刺组的中位反应时间和完全缓解疼痛时间均低于假针刺组(分别为5分钟对30分钟,对数秩检验<0.001;20分钟对未观察到,对数秩检验<0.001)。所有亚组的反应风险比(HR)均有利于针刺组。除基线时结石较大和中度疼痛外,所有完全缓解疼痛的HR均有利于针刺组。在这两个事件中均未发现交互作用。

结论

针刺可加快急性肾绞痛患者的反应时间和完全缓解疼痛时间,疗效具有普遍性。

试验注册

本研究已在中国临床试验注册中心注册:ChiCTR1900025202。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cc1a/10876610/cc3a94a28c4e/gr1.jpg

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