醒脑开窍针刺法治疗脑卒中后吞咽困难的有效性与安全性的系统评价

摘要

【目的】评价醒脑开窍针刺法治疗脑卒中后吞咽困难的疗效。【方法】计算机检索中文数据库如中国生物医学文献数据库（CBM）、中国学术文献网络出版总库（CNKI）、中文科技期刊数据库（维普VIP）和万方数据库（Wanfang Data），及外文数据库如PubMed、 Web of Science、 EMbase、 The Cochrane Library等（从数据库建库到2014年12月）有关醒脑开窍针刺法治疗脑卒中后吞咽困难的随机对照试验（RCT）的文献。由2位评价员按纳入和排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后，采用RevMan 5.3.0进行Meta分析。【结果】共纳入8个RCT，涉及766例患者。 Meta分析显示：（1）对于恢复期患者，疗程4周的醒脑开窍针刺法联合常规治疗（内科常规治疗或内科常规治疗+吞咽功能训练）总有效率高于不联合治疗组(P＜0.01)；（2）对于急性期患者，疗程4周的醒脑开窍针刺法联合内科常规治疗与不联合治疗的总有效率无差别(P=0.05)；（3）联合醒脑开窍针刺法对肺部并发症作用尚不确定。【结论】醒脑开窍针刺法联合常规治疗（吞咽功能训练、内科治疗）有利于脑卒中恢复期患者的吞咽功能恢复。对于脑卒中后吞咽困难的治疗时机、疗程、并发症等的疗效评估等仍然需要设计合理、报告规范的大规模、高质量的随机对照试验的验证。%Objective To systematically evaluate the effectiveness and safety of resuscitation-inducing acupuncture for post-stroke dysphasia. Methods The randomized controlled trials ( RCTs) of resuscitation-inducing acupuncture for post-stroke dysphasia were searched in the domestic and overseas databases such as CBM, CNKI, Weipu VIP, Wanfang Data, PubMed, Web of Science, EMbase and the Cochrane Library ( from the founded date to December of 2014) . Literature screening, information extracting and literature quality assessment were done by 2 reviewers independently. RevMan5.3.0 software was used for Meta analysis. Results A total of 8 RCTs were included into the analysis, involving in 766 cases. The results of Meta analysis showed:( 1) for patients in the recovery stage of stroke, 4-week resuscitation-inducing acupuncture combined with routine treatment including internal medicine plus swallowing function training or not had better efficiency than the control group without resuscitation-inducing acupuncture (P<0.001) ; (2) for patients in the acute stage, the difference of efficiency between the combination group and the control group was insignificant (P=0.05); (3) The efficiency of resuscitation-inducing acupuncture combined with routine treatment for the complication of pulmonary infection stayed uncertain. Conclusion Resuscitation-inducing acupuncture combined with routine treatment is recommended to the patients with dysphasia in the recovery stage of recovery. But the cure time window, treatment course and effectiveness evaluation still need to be confirmed by more large-scale, high-quality randomized controlled trials.