摘要
目的:应用Cochrane系统评价方法评价穴位刺激对预防预期性化疗相关恶心呕吐的效果。方法:计算机检索万方数据库、CNKI、维普中文科技期刊全文数据库(VIP)、中国生物医学文献服务系统、Cochrane Library、PubMed、EMbase、Elsevier、Springer,ClinicalKey for Nursing,辅以互联网络检索,检索时间设为建库至2019年11月,收集所有探讨穴位刺激预防预期性化疗相关恶心呕吐的随机对照试验和半随机对照试验,参考Cochrane Handbook 5.1.0评价标准进行质量评价,使用RevMan 5.0软件进行数据分析。结果:共纳入5篇文献(544例成人肿瘤住院患者,干预组269例,对照组275例),其中2篇为RCT,3篇为半随机对照试验;所有文献质量均为B级。涉及的穴位刺激包括3种,分别为耳穴疗法、穴位按摩、穴位贴敷。Meta分析结果显示,只有穴位贴敷(184例患者)的亚组分析结果显示,干预组在化疗相关恶心呕吐控制效果方面优于对照组(RR=1.12,95%置信区间为1.03~1.23,P=0.01);其余结果不论是对所有文献进行的Meta分析,还是基于不同恶心呕吐种类亚组分析、不同发生时间亚组分析、干预组是否联合止吐药物亚组分析或者耳穴疗法干预的亚组分析,结果均显示干预组与对照组差异无统计学意义(P>0.05)。不良反应Meta分析中,3篇文献分析不良反应的发生情况,其中2篇文献未观察到不良反应,1篇文献显示干预组(22%)的不良反应发生率低于对照组(52%)。抑郁得分Meta分析中,2篇文献(260例患者)评价抑郁得分情况,均采用随机效应模型,结果显示,干预组的抑郁症状得分低于对照组(MD=-11.72,95%置信区间为-19.82~3.62,P=0.005)。生活质量Meta分析中,2篇文献评价生活质量改善情况,由于数据无法合并,只做描述性分析,研究结果提示耳穴疗法能提高患者的生活质量。结论:尚不能认为穴位刺激可以缓解预期性化疗相关恶心呕吐,但是穴位刺激并没有增加不良反应的发生风险,且可减轻抑郁症状。
Objective To evaluate the effect of acupoint stimulation on the prevention of anticipatory chemotherapy-induced nausea and vomiting by using Cochrane systematic review method.Methods Wanfang database,China National Knowledge Infrastructure(CNKI),VIP Chinese Science and Technology Journal Full-text Database,SinoMed,Cochrane Library,PubMed,EMbase,Elsevier,Springer,ClinicalKey for Nursing were searched by computer,which were supplemented by Internet retrieval,and the retrieval time was from set of these databases to November 2019.All randomized controlled trials and semi-randomized controlled trials that explored acupoint stimulation for the prevention of anticipated chemotherapy-induced nausea and vomiting were collected.The quality was evaluated by reference to Cochrane Handbook 5.1.0,and the data were analyzed with RevMan 5.0 software.Results A total of 5 papers were included(544 adult tumor inpatients,269 in the intervention group and 275 in the control group),of which 2 were randomized controlled trials and 3 were semi-randomized controlled trials.All literatures were grade B in quality.There were 3 kinds of acupoint stimulation involved,which were auricular therapy,acupoint massage and acupoint application.Meta-analysis results showed that only the subgroup analysis of acupoint application(184 patients)showed that the intervention group was superior to the control group in terms of the control effect of chemotherapy-induced nausea and vomiting(RR=1.12,95%CI 1.03-1.23,P=0.01).Other results showed no statistically significant difference between the intervention group and the control group,either in the Meta-analysis of all literatures,or in the subgroup analysis based on different types of nausea and vomiting,different time of occurrence,whether the intervention group combined with antiemetic drugs or auricular therapy intervention(P>0.05).In the Meta-analysis of adverse reactions,3 literatures analyzed the occurrence of adverse reactions,among which 2 literatures did not observe adverse reactions,and 1 literature showed that the incidence of adverse reactions in the intervention group(22%)was lower than that in the control group(52%).In the Meta-analysis of depression scores,two literatures(260 patients)evaluated depression scores,using random effect model.The results showed that the depressive symptoms score of the intervention group was lower than that of the control group(MD=-11.72,95%CI-19.82-3.62,P=0.005).In the Meta-analysis of quality of life,2 literatures evaluated the improvement of quality of life.Since the data could not be combined and only descriptive analysis was performed,the results suggested that auricular therapy could improve quality of life of patients.Conclusions Acupuncture point stimulation is not yet considered to relieve anticipatory chemotherapy-induced nausea and vomiting,but it does not increase the risk of adverse reactions and it can reduce depressive symptoms.
作者
王旭梅
王莉
吴心怡
郭欣
丁亚光
马晓莉
Wang Xumei;Wang Li;Wu Xinyi;Guo Xin;Ding Yaguang;Ma Xiaoli(Hematology Oncology Center,National Center for Children's Health,China&Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Nursing,National Center for Children's Health,China&Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)
出处
《中华现代护理杂志》
2020年第30期4200-4209,共10页
Chinese Journal of Modern Nursing
基金
2018年北京市中医药科技发展资金项目护理专项(JJ2018-67)。
关键词
穴位刺激
恶心
呕吐
化学疗法
预期性
META分析
Acupoint stimulation
Nausea
Vomiting
Chemotherapy
Anticipatory
Meta-analysis
