摘要
目的:系统评价针灸结合康复治疗卒中后抑郁患者临床疗效。方法:通过计算机检索涉及针灸结合康复治疗卒中后抑郁的临床研究类型的文献,检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Web of Science、EMbase、The Cochrane Library,收集建库以来至2020年10月期间发表的关于针灸结合康复治疗卒中后抑郁的临床随机对照试验,采用RevMan 5.3软件录入和分析数据,逐一评价纳入研究的质量,对汉密顿抑郁量表(HAMD)、日常生活能力量表(ADL)、美国国立卫生研究院卒中量表(NIHSS)、有效率等数据进行Meta分析。结果:检索出相关文献310篇,最终纳入11篇文献,共获1 065例卒中后抑郁患者,其中针灸结合康复治疗组545例,常规内科用药组371例,其他疗法组149例。Meta分析结果显示针灸结合康复治疗卒中后抑郁的有效率优于内科常规用药组[有效率RR=1.20,95%CI (1.12,1.29),Z=4.96,P<0.000 01]及其他单一疗法组[RR=1.26,95%CI (1.02,1.56),Z=2.18,P=0.03];其次,针灸结合康复治疗比常规内科用药以及其他单一疗法更能改善患者的神经缺损功能[NIHSS值WMD=4.17,95%CI (2.35,6.00),Z=4.49,P<0.000 01],对改善患者焦虑抑郁情绪更显著[HAMD值WMD=4.20,95%CI (3.35,5.06),Z=9.65,P<0.000 01];对患者日常生活能力的提高有明显的优势[ADL值WMD=23.17,95%CI (21.25,25.09),Z=23.65,P<0.000 01]。结论:针灸结合康复治疗卒中后抑郁疗效确切,在临床的推广及应用中有一定的参考价值。但鉴于纳入研究质量有待提高,应用时应谨慎对待其有效性。未来仍需高质量、大样本、多中心的随机临床研究加以证实。
Objective:To systematically evaluate the clinical efficacy the clinical efficacy of acupuncture and moxibustion combined with rehabilitation in the treatment of post-stroke depression.Methods:By computer and manual retrieval,literatures about clinical trials on acupuncture and moxibustion and rehabilitation in treating post-strokedepression published before October of 2020 were collected from China National Knowledge Infrastructure(CNKI),WanFang database,Vip database,China Biology Medicine disc(CBMdisc),PubMed,Web of Science,EMbase and The Cochrane Library.RevMan5.3 software was used to input and analyze data,and the quality of included studies was evaluated one by one.Metaanalysis was performed on Hamilton Depression Scale(HAMD),Activity of Daily Living Scale(ADL),National Institute of Health Stroke Scale(NIHSS) and effective rate.Results:A total of 310 articles were retrieved and 11 articles were finally recruited,including 1 065 patients with post-stroke depression,545 cases treated by acupuncture and moxibustion combined with rehabilitation,371 by medicine and 149 by other single method.The Meta-analysis showed that needling combined with rehabilitation produced more significant effective rate than and [medicine(effective rate):RR=1.20,95% CI(1.12,1.29),Z=4.96,P<0.000 01].Other single method(effective rate) [RR=1.26,95%CI(1.02,1.56),Z=2.18,P=0.03].Moreover,needling combined with rehabilitation produced a better effect in improving nerve function,[NIHSS:WMD=4.17,95% CI(2.35,6.00),Z=4.49,P<0.000 01].It can significantly improve the anxiety and depression of patients,[HAMD:WMD=4.20,95% CI(3.35,5.06),Z=9.65,P<0.000 01],showing an advantage in activity of daily life[ADL:WMD=23.17,95% CI(21.25,25.09),Z=23.65,P<0.000 01].Conclusion:Acupuncture and moxibustion combined with rehabilitation is effective in the treatment of post-stroke depression,which has certain reference value in clinical application and promotion.However,due to the quality of included researches need to be improved,its effectiveness should be treated with caution in application.In the future,high quality,large sample and multi-center randomized clinical studies are still needed to confirm.
作者
吴碧雯
杨小勇
WU Biwen;YANG Xiaoyong
出处
《新中医》
CAS
2022年第9期158-165,共8页
New Chinese Medicine
基金
宁波市医学科技计划项目(2020Y38)。
关键词
卒中后抑郁
针刺疗法
康复治疗
META分析
Post-stroke depression
Acupuncture therapy
Rehabilitation
Meta-analysis
