Kim Mikyung, Han Changho
Department of Internal Medicine, Dongguk University Ilsan Oriental Hospital, Goyang-si 10326, Republic of Korea.
Department of Internal Medicine, Dongguk University WISE Campus, Gyeongju-si 38066, Republic of Korea.
Healthcare (Basel). 2024 Oct 17;12(20):2060. doi: 10.3390/healthcare12202060.
Bloodletting is a non-pharmacological treatment commonly used for acute stroke in traditional East Asian medicine. This study evaluated the efficacy and safety of bloodletting in acute stroke recovery.
We conducted a comprehensive search of eight electronic databases up to 4 June 2024 to identify relevant randomized controlled trials (RCTs). Review Manager 5.4 was used for the meta-analysis, with methodological quality assessed using the Cochrane Risk of Bias 2 tool and the GRADE approach.
Seventeen RCTs were included in this meta-analysis. The bloodletting group showed statistically significant improvements in neurological deficits compared to the non-bloodletting group, as measured using the National Institutes of Health Stroke Scale (mean difference [MD]: -2.08, 95% confidence interval [CI]: -3.13 to -1.02) and the treatment effective rate (risk ratio: 1.17, 95% CI: 1.11 to 1.22). Motor function also improved significantly in both upper (Fugl-Meyer Assessment, MD: 12.20, 95% CI: 9.67 to 14.73) and lower extremities (MD: 3.86, 95% CI: 2.16 to 5.56). The effect on daily living activities was not significant overall, but benefits were observed in patients treated within three days of stroke onset (Barthel Index, standardized MD: 0.85, 95% CI: 0.01 to 1.69). No significant differences in the frequency of adverse events were observed between the groups.
Bloodletting may be an effective and safe adjunctive therapy for patients with acute stroke receiving conventional Western medical treatment. However, further research is necessary because of the small sample sizes and low quality of the included studies.
放血疗法是东亚传统医学中常用于急性中风的一种非药物治疗方法。本研究评估了放血疗法在急性中风恢复中的疗效和安全性。
我们对截至2024年6月4日的八个电子数据库进行了全面检索，以识别相关的随机对照试验（RCT）。使用Review Manager 5.4进行荟萃分析，采用Cochrane偏倚风险2工具和GRADE方法评估方法学质量。
本荟萃分析纳入了17项随机对照试验。与不放血组相比，放血组在神经功能缺损方面有统计学意义的改善，采用美国国立卫生研究院卒中量表测量（平均差[MD]：-2.08，95%置信区间[CI]：-3.13至-1.02）以及治疗有效率（风险比：1.17，95%CI：1.11至1.22）。上肢（Fugl-Meyer评估，MD：12.20，95%CI：9.67至14.73）和下肢（MD：3.86，95%CI：2.16至5.56）的运动功能也有显著改善。对日常生活活动的总体影响不显著，但在中风发病三天内接受治疗的患者中观察到了益处（Barthel指数，标准化MD：0.85，95%CI：0.01至1.69）。两组之间不良事件的发生率没有显著差异。
对于接受传统西医治疗的急性中风患者，放血疗法可能是一种有效且安全的辅助治疗方法。然而，由于纳入研究的样本量小且质量低，有必要进行进一步研究。
