中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (4): 583-588.doi: 10.4103/1673-5374.155431

• 综述:脑损伤修复保护与再生 • 上一篇    下一篇

醒脑开窍法针刺治疗缺血性脑卒中：远期疗效的系统评价

  

  • 收稿日期:2015-02-11 出版日期:2015-04-22 发布日期:2015-04-22
  • 基金资助:

    河北省科学技术研究与发展计划项目（11276103d-35）

Systematic review of long-term Xingnao Kaiqiao needling efficacy in ischemic stroke treatment

Zhi-xin Yang 1, Jia-hong Xie 2, Yong-ping Liu 2, Guang-xin Miao 1, Ying-han Wang 2, Sheng-mei Wu 3, Yuan Li 3   

  1. 1 Department of Traditional Chinese Medicine, Chengde Medical University, Chengde, Hebei Province, China
    2 Key Laboratory of Traditional Chinese Medicine Research and Development, Institute of Traditional Chinese Medicine, Chengde Medical
    University, Chengde, Hebei Province, China
    3 Chicheng Hospital of Traditional Chinese Medicine, Chicheng, Hebei Province, China
  • Received:2015-02-11 Online:2015-04-22 Published:2015-04-22
  • Contact: Zhi-xin Yang, Ph.D., yzx19972003@163.com.
  • Supported by:

    This study was financially supported by grants from Hebei Province Engineering Talent Cultivation Project and Hebei Province Science and Technology Research and Development Projects, No. 11276103D-35.

PDF

930

摘要：

目的：系统评价醒脑开窍针刺治疗缺血性脑卒中的远期疗效及安全性。
资料来源：检索2006年5月-2014年7月发表在中国期刊全文数据库、维普数据库、万方数据库、中国生物医学文献数据库及Cochrane Library、PUBMED数据库。醒脑开窍针刺治疗缺血性脑卒中的随机与半随机对照试验。
资料选择：根据 Cochrane系统评价员手册 5.1版评价文献质量及Cochrane系统评价方法进行评价。采用RevMan 5.2软件对纳入的醒脑开窍法针刺治疗缺血性脑卒中的随机与半随机对照试验进行meta分析。
主要观察指标：死亡率，复发率和残疾率
结果：本系统评价共纳入9项醒脑开窍法针刺治疗缺血性脑卒中的随机与半随机对照试验，治疗组在对照组的基础疗法之上均采用了醒脑开窍针刺疗法进行治疗，共931例缺血性脑卒中患者。Meta分析结果显示：醒脑开窍法针刺治疗缺血性脑卒中在降低病死率[RR=0.58, 95%CI: 0.17-1.93), Z=0.89, P > 0.05]、复发率[RR=0.55, 95%CI: 0.18-1.70, Z=1.04, P > 0.05]方面与对照组相比差异无显著性意义，但存在优于对照疗法的趋势[RR=0.55, 95%CI: 0.18-1.70, Z=1.04, P > 0.05]；在降低残疾率方面明显优于对照组[RR=0.51, 95%CI: 0.27-0.98, Z=2.03, P < 0.05]。
结论：醒脑开窍针刺治疗缺血性脑卒中有降低病死率、复发率的趋势，在降低残疾率方面作用尤其显著。说明醒脑开窍法针刺治疗缺血性脑卒中远期疗效较好。但由于研究存在的局限性，降低了系统评价结论的论证强度，尚期待设计合理、执行严格、多中心、大样本且随访时间足够的随机对照试验予以进一步验证。

关键词: 神经再生, 醒脑开窍针刺, 缺血性脑卒中, 随机对照试验, 系统评价, Meta-分析, 远期疗效, 死亡率, 复发率, 残疾率, 不良反应, 经济学指标

Abstract:

OBJECTIVE: To systematically evaluate the long-term effect and safety of Xingnao Kaiqiao needling method in ischemic stroke treatment.
DATA RETRIEVAL: We retrieved relevant random and semi-random controlled trials that used the Xingnao Kaiqiao needling method to treat ischemic stroke compared with various control treatments such as conventional drugs or other acupuncture therapies. Searched databases included China National Knowledge Infrastructure, Weipu Information Resources System, Wanfang Medical Data System, Chinese Biomedical Literature Database, Cochrane Library, and PubMed, from May 2006 to July 2014.
SELECTION CRITERIA: Two authors independently conducted literature screening, quality evaluation, and data extraction. The quality of articles was evaluated according to the Cochrane Reviewers’ Handbook 5.1, and the study was carried out using Cochrane system assessment methods. RevMan 5.2 was used for meta-analysis of the included studies.
MAIN OUTCOME MEASURES: Mortality rate, recurrence rate, and disability rate were observed.
RESULTS: Nine randomized and semi-randomized controlled trials treating 931 cases of ischemic stroke were included in this review. Meta-analysis results showed that there were no significant differences in mortality reduction (risk ratio (RR) = 0.58, 95% confidence interval (CI): 0.17–1.93, Z = 0.89, P = 0.37) or recurrence rate (RR = 0.55, 95%CI: 0.18–1.70, Z = 1.04, P = 0.30) of ischemic stroke patients between the Xingnao Kaiqiao needling and control treatment groups. However, the Xingnao Kaiqiao needling method had a tendency towards higher efficacy in mortality reduction and recurrence rates. The Xingnao Kaiqiao needling method was significantly better than that of the control treatment in reducing disability rate (RR = 0.51, 95%CI: 0.27–0.98, Z = 2.03, P < 0.05).
CONCLUSION: The Xingnao Kaiqiao needling method has a better effect than control treatment in reducing disability rate. The long-term effect of Xingnao Kaiqiao needling against ischemic stroke is better than that of control treatment. However, the limitations of this study limit the strength of the conclusions. Randomized controlled trials with a strict, reasonable design, and multi-center, large-scale samples and follow-up are necessary to draw conclusions about Xingnao Kaiqiao needling.

Key words: nerve regeneration, Xingnao Kaiqiao needling method, ischemic stroke, randomized controlled trial, systemic reviews, meta-analysis, long-term efficacy, mortality, recurrence, disability, adverse reactions, health economics indicators, neural regeneration