摘要
Objective： To systematically evaluate the therapeutic efficacy of tuina therapy for primary insomnia. Methods： Nine Chinese and English databases were searched from the inception to May 2017 to identify randomized controlled trials （RCTs） studying tuina therapy for insomnia. The enrolled articles were all RCTs with tuina as the monotherapy or major therapy in the experiment group, with clear diagnostic criteria for primary insomnia well recognized worldwide or in China, and Pittsburgh sleep quality index （PSQI） as one of the outcome measures. Two researchers evaluated the risk of bias and quality of the enrolled studies by following Cochrane Handbook version 5.1.0. The meta-analysis was performed by RevMan version 5.3. Results： Eleven studies were included with a total of I 076 participants. The Western medication adopted in the control groups were benzodiazepine receptor agonists. The studies were all assessed as high risk of bias for blinding since blinding method was unable to be performed due to the specificity of tuina therapy; no study reported the support of fund or potential interest conflict, so they were all rated unclear for selective reporting. The meta-analysis showed that compared with other traditional Chinese medicine therapies, tuina worked more effectively in reducing the PSQI score （MD=-4.11〈O, 95% confidence interval （CI） -6.01 to -2.22, P〈0.O001）; compared with oral administration of Western medication, tuina showed more significant efficacy in reducing the PSQI score （MD=-3.42〈0, 95%CI -5.19 to -1.66, P〈0.O001）. Subgroup analysis showed that head tuina alone showed no significant difference compared with oral administration of Western medication regarding the change of PSQI score （MD=-4.19〈O, 95%CI -8.87 to 0.50, P〉0.05）; a combination of head and back tuina could more effectively reduce the PSOJ score compared with oral administration of Western medication （MD=-2.08〈O, 95%CI -3.09 to -1.06, P〈0.O001）. Conclusion： Tuina can produce more significant efficacy in treating primary insomnia compared with other traditional Chinese medicine therapies and oral administration of Western medication, especially the combination of head and back tuina.
目的：系统评价推拿疗法治疗原发性失眠的疗效。方法：共检索9个中英文数据库中用推拿疗法治疗失眠的随机对照试验，检索时间为从数据库建立起至2017年5月。纳入文献均为随机对照试验、试验组单独使用推拿或以推拿为主、有明确的国际或国内公认的原发性失眠诊断标准、结局指标中有匹兹堡睡眠质量指数（PSQJ）。由两名研究者按照CochraneHandbook5．1．0对每个纳入研究进行偏倚风险和质量评估，并使用RevMan5．3软件进行Meta分析。结果：共纳入儿项研究，1076例患者。对照组中采用的西药均为苯二氮革受体激动剂。偏倚性分析显示，因推拿疗法的特殊性，盲法无法实现，所以盲法风险均为高风险，选择性报告的偏倚性分析因未提供足够的信息而不清楚，所有文献均未报告获得了资金支持或有潜在的利益冲突。对纳入文献进行meta分析显示，推拿疗法与其他中医疗法比较，合并MD=-4．P〈0.95％CI[6．01，-2．22]，P〈0．0001，提示推拿疗法能更有效地降低患者PSQI评分；推拿疗法与口服西药比较，合并MD=-3．42〈0，95％CI[-5．19，-1．66]，P〈0.0001，提示推拿疗法能更有效地降低患者PsQl评分。按推拿部位不同进行亚组分析显示，单纯头部推拿与口服西药比较，PsQI评分差异（无统计学意义，合并MD=-4．19〈0，95％CI[-8．87，0．50]，P〉0．05，头部结合背部推拿与口服西药比较，合并MD=-2．08〈0.95％CI[-3．09，-1．06]，P〈0.0001，提示头部结合背部推拿可更有效地降低患者PSQI评分。结论：推拿治疗原发性失眠的疗效优于其他中医疗法和口服西药治疗，且头部结合背部推拿更佳。
