穴位注射治疗癌痛随机对照研究的Meta分析

摘要

Objective To assess the efficacy and security of point injection for cancer pain with evidence-based medicine method.[Methods]A retrieval on literatures concerning treatment of cancer pain with point injection was carried out in databases of Cochrane Library, EMBASE, Pubmed, CMB, CNKI, VIP and WANFANG. And meta-analysis was conducted on randomized control ed trials(RCT) which met the enrol ing requirements. [Results]A total number of 13 papers involving 1293 patients were included. The result indicated that effect of point injection to reduce pain was better than the conventional medication,was statistical y significant(95% CI 1.22 to 1.48, P<0.00001), and had shorter effective time(95% CI 23.42 to 6.37, P=0.0006), longer duration time of analgesia(95% CI 8.75 to 13.76, P<0.00001). Point injection can reduce nausea and vomiting caused by opioids(95% CI 0.3 to 0.03, P=0.02), but cannot reduce the incidence of constipation, dizziness and headache(95% CI-0.3 to 0.03, P=0.12 and 95% CI-0.26 to 0.03, P=0.13). [Conclusion]Point injection can reduce cancer pain, and have advantage of shorter effective time, longer duration time of analgesia. It reduces nausea and vomiting caused by opioids, but does not reduce the incidence of constipation, dizziness and headache. However, since the number of RCT literatures was less, especial y high-quality, large samples and multi-center reports were not enough. Further studies are stil necessary for approving the conclusions.%[目的]运用循证医学方法评价穴位注射治疗癌痛的有效性和安全性。[方法]计算机检索Cochrane Library、EMBASE、Pubmed、中国生物医学文献数据库、中国知网、重庆维普、万方数据库，检索所需的随机对照试验（RCT）文献进行Meta分析。[结果]共纳入13个研究，合计1293例癌痛病例，分析发现穴位注射减轻患者疼痛效果优于常规药物治疗,有统计学意义(95%CI 1.22～1.48，P<0.00001)，并且具有起效时间短（95%CI-23.42～-6.37， P＝0.0006），止痛维持时间长的优势（95%CI 8.75～13.76，P<0.00001）。同时，穴位注射可以减少阿片类药物使用过程中恶心呕吐的发生（95%CI-0.3～-0.03，P=0.02）,但不能降低便秘和头晕头痛的发生率（95%CI-0.3～0.03，P＝0.12和95%CI-0.26～0.03，P=0.13）。[结论]穴位注射可以减轻癌痛患者疼痛，并具有起效时间短，止痛时间长的优势，同时可以减少阿片类药物使用过程中恶心呕吐的发生，但不能减少便秘和头晕头痛的发生。由于纳入文献数量过少，特别是高质量、多中心的文献极少，因此上述结果还需深入研究。