穴位贴敷治疗小儿泄泻有效性的Meta分析

摘要

Objective To analyze the effectiveness of acupoint application therapy for infantile diarrhea so as to provide an objective evidence for clinical decision making.Methods The authors of the present paper did a literature retrieval using The China National Knowledge Infrastructure (CNKI) database,Chinese bio-medical database and Wanfang database covering the period of January 1,1990-June 30,2012,and made a systemic evaluation on the retrieved randomized controlled clinical trials (RCTs) of acupoint application therapy for infantile diarrhea using Cochrane system evaluation method.Following excluding the repetitive,irrelevant and non-randomized controlled trials,those meeting the standards of randomized controlled trials were collected.Trial quality was assessed using the Jadad score which evaluates the randomization process,blinding,and the description of withdrawals or dropouts.The RevMan 5.1 software was used to make statistical analysis.Results A total of 16 papers (2 151 patients) were included in the Meta analysis.The homogeneity test was better (x2 =8.09,P=0.92,I2 =0％),displaying a homogenicity of most studies.Meta analysis showed the merger effect quantity odds ratio (OR)=4.68,and 95 ％ confidence intervals (CIs):3.41,6.42,and the merger effect value test Z=9.58,P＜0.00001.Statistical difference indicates a better therapeutic effect of acupoint application group than the control group,providing evidence in favor of acupoint application therapy for infantile diarrhea.Funnel chart displays that the researched object distribution is symmetric,being smaller in the bias.But the potential publication bias still possibly exists.Conclusion Acupoint application therapy for infantile diarrhea has some advantages,which needs further confirmation due to lower quality of the collected literatures.Larger sample,high quality and randomized controlled clinical trials are highly recommended.%目的:评价穴位贴敷治疗小儿泄泻的有效性,为临床决策提供客观依据.方法:采用Cochrane系统评价的方法对穴位贴敷治疗小儿泄泻的随机对照试验进行系统评价.电子检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,年限为1990年1月1日至2012年6月30日.在排除重复、无关及非随机对照试验后,筛选出符合纳入标准的穴位贴敷治疗小儿泄泻的随机对照试验.应用Jadad评分量表对符合入选标准的随机对照研究进行质量评价,并用专用软件RevMan 5.1版进行统计分析.结果:共纳入16篇文献,共2 1 51例患者纳入本次研究.16篇研究同质性较好,Meta分析结果显示,合并效应量OR=4.68,95％CI(3.41,6.42),合并效应量的检验Z=9.58,P＜0.00001,差异有统计学意义,提示穴位贴敷组优于对照组,可认为穴位贴敷治疗小儿泄泻有效,相比其它疗法疗效更高.漏斗图显示研究对象分布较为对称,可认为该研究的偏倚较小.结论:穴位贴敷治疗小儿泄泻有一定优势,但由于纳入评价的文献普遍质量不高,尚有待补充一些大样本、高质量、方法学规范的随机对照试验来完善.