针灸治疗面瘫临床常用治法与刺法的评价

目的　了解建国以来针灸治疗面瘫的临床研究现状及能否向临床实践提供有可靠依据的治法和刺法。方法　采用循证医学和临床流行病学评价文献质量的原则和方法对针灸治疗面瘫的临床研究文献进行全面检索和方法学质量评价。结果　在实际检出的 96 3篇文献中 ,随机对照试验 (RCT)的文献 83篇 ,目前 RCT提供了针灸治疗面瘫有效的可靠依据及针灸治疗面瘫常用的治法与刺法。结论　针灸治疗面瘫最常用的治疗方法是毫针、电针、灸法等 ,最常用的针刺方法是透刺法、浅刺法等 ,而且透刺法优于浅刺法。     

ASSESSMENT OF THE QUALITY OF REPORTING FOR TREATMENT COMPONENTS IN COCHRANE REVIEWS OF ACUPUNCTURE

Objective: High-quality reporting of treatment details can aid replication of study results in real-world clinical practice.The Standards for Reporting Interventions in Clinical Trials of Acupuncture(STRICTA) is a reporting guideline for key elements of acupuncture interventions in clinical trials.This study used STRICTA to investigate whether Cochrane reviews of acupuncture adequately report important treatment details.Design: Systematic review methods: Cochrane reviews of acupuncture were identified from The Cochrane Library(Issue 7, 2012).Randomized controlled trials(RCTs) included in the reviews and published after 2005 were obtained.Using STRICTA, we extracted acupuncture-related information from both the Cochrane reviews and the RCTs.The characteristics of included studies table were the major source of intervention information from Cochrane reviews.Reporting quality of acupuncture interventions in Cochrane reviews was assessed and compared to the respective RCTs.Results: Twenty-five Cochrane reviews of acupuncture and 92 RCTs met the selection criteria.Cochrane reviews were 16% less likely to report the acupuncture-related items of STRICTA than RCTs(risk ratio 0.84, 95% confidence interval 0.79 to 0.88, I2=8%).Information was significantly better reported for 10 of the 15 treatment-group items of STRICTA in RCTs than in Cochrane reviews(P0.05), while four items did so without statisticalsignificance.One item related to practitioner background was significantly better reported in Cochrane reviews.Conclusion: Reporting quality of treatment details in Cochrane reviews of acupuncture was insufficient with regard to STRICTA, even though such information was readily reported in RCTs.The overall quality of reporting of the RCTs, while better than the reviews, was also often suboptimal.Use of STRICTA guideline during the review process is recommended to adequately report the key treatment components in Cochrane reviews of acupuncture.The potential impact of STRICTA to the replicability and utilization of reviews in future research and practice needs to be investigated.     

针灸治疗腰痛临床常用治法与刺法的评价

目的:了解近10年针灸治疗腰痛的临床研究现状及能否向临床实践提供有可靠依据的治法和刺法。方法:采用循证医学和临床流行病学评价文献质量的原则和方法对针灸治疗面瘫的临床研究文献进行全面检索和方法学质量评价。结果:在实际检出的302篇文献中,随机对照试验(RCT)的文献31篇,目前RCT提供了针灸治疗腰痛可靠的依据及常用的治法与刺法。结论:针灸治疗腰痛最常用的治疗方法是毫针、拔罐、牵引等,深刺优于浅刺,仓龟探穴法效果良好。     

FACTORS THAT MAY CONTRIBUTE TO THE INSTANT ANALGESIC EFFECTS OF ACUPUNCTURE FOR PRIMARY DYSMENORRHEA IN CLINICAL RANDOMIZED TRIALS

Objective: There are a great many variables in acupuncture treatment(e.g., point selection, the number of points selected, Chinese medicine patterns, acupuncture manipulation, different intervention time of acupuncture, duration of needling, number and frequency of sessions and needling sensation), all of which need to be addressed in designing and reporting clinical trials.We aim to find the factors that may affect the instant analgesic effects of acupuncture on primary dysmenorrhea in randomized controlled trials(RCTs).Methods: We reviewed factors involved in RCTs in three systematic reviews about acupuncture for primary dysmenorrhea.Results: The overall findings of this literature review suggested that the durations of needling in most RCTs lasted for 20-40 min, and the number and frequency of sessions were likely to last for 5-7 d and continued for three sessions.However, those variables of stimulation including point selection, number of points used, Chinese medicine pattern, acupuncture manipulation and different intervention time of acupuncture were particularly diverse from each other in treatment for primary dysmenorrhea.Conclusion: Our findings reinforce the understanding of acupuncture as a complex intervention.To identify how each component contributes to the instant analgesic effect, well-designed trials comparing those interventions head to head would be a practical and realistic approach to establish optimally effective acupuncture for primary dysmenorrhea.Few rigorous studies have compared the relative efficacy of different acupuncture treatment components within their protocols.Conclusive agreement on those parameters supporting the optimal treatment for patients has not been achieved.Due to the poor quality of available evidence shown in current statues, controlled comparative studies looking at every relevant variable of treatment for primary dysmenorrhea ought to be paid more attention, which may help clinical trials to improve transparency and standardize treatment efficacy.     

针刺治疗呃逆疗效的系统评价

目的：系统评价针刺在治疗呃逆中的疗效,为针刺在呃逆治疗中的应用提供依据。方法：检索针刺治疗呃逆的随机对照试验研究的文献,对其进行Meta分析。结果：共纳入包括547名受试者在内的随机对照试验8个,Jadad评分2个2分,6个为1分,且所有研究均处于C级,质量不高。针刺疗法与非针刺疗法相比,总体疗效合并OR=10.45,95%CI[6.28-17.39];漏斗图显示研究存在一定的发表偏倚。结论：现有临床研究证据表明针刺疗法在治疗呃逆存在一定的优势,未见明显不良反应的报道,但由于纳入研究数量有限,且质量不高,影响了本次评价的效度,中医临床科研的质量有待提高。     

针刺治疗中风后痉挛性瘫痪的系统评价

对针刺治疗中风后痉挛性瘫痪的随机对照试验(RCT)或半随机对照试验(quasi-RCT)按Cochrane协作网推荐的方法进行系统评价.14篇中文文献978例患者满足纳入标准,但均为低质量试验.纳入的9个试验进行Meta分析结果显示:Ashworth评分、Carr-Shepherd运动评分、神经功能缺损程度评分、髋内收肌张力评分中试验组和对照组均无差别,而Fugel-Meyer评分中1项研究、Barthel指数评分中3项研究试验组优于对照组.由于纳入研究数量和质量上的缺陷,尤其是缺乏远期功能性结局指标,虽显示针刺有改善中风后痉挛性瘫痪的趋势,无不良反应,但目前尚不能对其疗效得出肯定结论,因此开展更多高质量、多中心的RCT非常必要.     

Effect of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis: A systematic review and meta-analysis

Objective

The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.

中医药治疗中风后抑郁症临床文献的质量评价

目的评价中医药治疗中风后抑郁症（PSD）的疗效与安全性,提出该领域临床研究方法学上存在的问题及对策。方法以循证医学的原则和方法,对2009年以前中国生物医学文献数据库、中国期刊全文数据库、重庆维普中丈科技期刊数据库、PUBMED、EMbase及相关杂志发表的关于中医药治疗PSD的临床随机对照试验（RCT）和临床对照试验（CCT）临床文献进行质量评价。结果符合纳入标准的RCT69篇、CCT6篇,仅11篇随机方法适当,2篇采用盲法,62篇有组间可比性,8篇提及退出和失访情况;纳入试验的方法学Jadad评分3分者4篇;2分者11篇;55篇得分0～1分;中药治疗或中西医结合治疗组有效率高于单纯西药治疗组,无效率、不良事件发生次数和程度低于单纯西药治疗组;有4篇研究可进行Meta分析。结论中医药治疗PSD研究质量有待进一步提高。Meta分析及定性研究所得中药或中西医结合治疗PSD肯定的疗效与安全性证据强度不够,需大样本、多中心、前瞻性的RCT以增加证据可靠性,并随新临床结果的出现不断完善与更新该评价。     

ON-SITE QUALITY CONTROL OF ACUPUNCTURE RANDOMIZED CONTROLLED TRIALS

Objective: To assure quality of acupuncture randomized controlled trials(RCTs) and to get good quality control contents.Methods: To analyze impact factors of quality of acupuncture RCTs through the series of brainstorming and thorough interview with consideration of the science, contents, quality control and their feasibility at site, at the same time this article made several references to quality control contents of traditional Chinese medicine interview RCTs which were researched by our team.Results: Patients, intervention, comparison and outcome(PICO), as key factors for the design of RCTs, are important contents for quality control of acupuncture RCTs.Especially intervener technology level and blind evaluation are crucial impact factors of quality of acupuncture RCTs and they can be observed and controlled directly on-site.Conclusion: Quality control contents based on PICOST assure quality of acupuncture RCTs.     

针刺治疗周围性面瘫文献中的若干问题及其建议

目的:分析针刺治疗周围性面瘫文献中存在的若干问题,并提出相应的改进建议。方法:利用计算机网络通过中国医院知识仓库系统(CHKD),检索了817篇针刺治疗周围性面瘫文献,并进行整理、归纳。结果:发现在针刺治疗周围性面瘫文献中,对临床资料相关信息、顽固性面瘫的称谓命名、后遗症与并发症的区分使用及治愈标准的把握等诸方面认识不够。结论:在针刺治疗周围性面瘫的文献中存在着具有一定普遍性和代表性的问题,它可能会对针刺治疗周围性面瘫的理论及临床研究产生错误的思维定势。充分认识并解决好上述问题,不仅可以提高针刺治疗周围性面瘫文献的整体质量,还可对临床诊治周围性面瘫的整体水平产生积极的影响。     

Overview of the systematic reviews of premature ovarian insufficiency treated with acupuncture 针灸治疗早发性卵巢功能不全系统评价的再评价

ObjectiveTo assess the reliability of the methodological quality and outcome measures of systematic reviews (SR)/meta-analysis of premature ovarian insufficiency (POI) treated with acupuncture.MethodsSR/meta-analysis of POI treated with acupuncture were searched on POI from the databases including PubMed, Web of Science, EMBase, the Cochran Library, Chinese biomedical literature database (SinoMed), China journal full-text database (CNKI), Wanfang data knowledge service platform (Wanfang) and VIP information Chinese periodical service platform (VIP), from inception to 1st May 2021. Using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) scale and Grades of Recommendations Assessment, Development and Evaluation (GRADE) system, the methodological quality and outcome measures of the included studies were appraised.ResultsTen articles of SR/meta-analysis were included, published from 2015 to 2020. Using AMSTAR 2, 5 articles of SR/meta-analysis were rated as critical low quality in methods, 3 articles as low quality, and 2 articles as moderate quality. The results of GRADE showed that among the 50 outcomes the quality of evidence of 22 outcomes was very low, that of 25 outcomes was low and that of 3 outcomes was moderate.ConclusionThe methodological quality and the reliability of outcome measures were not high in existing SR/meta-analysis on POI treated with acupuncture, which may affect the translation of the SR/meta-analysis findings into clinical practice. It is necessary to further strengthen the methodological quality and reporting standard of SR/meta-analysis, as well as the robustness of design and implementation of randomized controlled trials(RCTs), in order to generate high quality evidences for clinical decision-making and practice.     

针灸治疗顽固性面瘫的临床研究进展

对近年来针灸治疗顽固性面瘫的临床研究进展进行综述。分别从顽固性面瘫的病因病机、常用的治疗方法以及针灸治疗顽固性面瘫穴位的选择进行整理和分析,并尝试探讨目前临床治疗中的问题以及提出更好地解决方法。为今后的科研和临床提供参考依据。     

针灸治疗轻、中度原发性高血压随机对照试验的Meta分析

目的:采用Meta分析系统评价针灸与西药治疗轻、中度原发性高血压的临床疗效和安全性差异。方法:全面检索针灸与西药比较治疗轻、中度原发性高血压的随机对照试验文献,选择合格研究并进行质量评价,采用RevMan5.1软件进行meta分析。结果:共纳入10个随机对照试验包括782例患者。Meta分析结果:①降压疗效:单用针灸与单用西药比较,2组降压疗效无明显差异;针灸+西药与单用西药比较,针灸+西药组明显优于单用西药组;②症状疗效:单用针灸或针灸+西药均优于单用西药,纳入试验中未见不良反应报道。结论:针灸治疗轻、中度原发性高血压安全有效。但本研究纳入试验数有限且多数文献质量较低,需设计更严格的随机对照试验来进一步验证上述结论。     

针灸治疗带状疱疹文献质量评价与施治规律探讨

目的：对针灸治疗带状疤疹的临床研究文献进行质量评价。方法：电子检索1994-2006年研究文献。按照临床流行病学和循证医学的原则和方法，对临床研究类型及方法学、一般情况、疾病诊断及纳入和排除标准、样本含量估计、治疗情况、疗效判定标准、随谚等方面进行评价。结果：在399篇纳入文献中，真正随机对照试验仅8个；半随机对照试验20个；非随机同期对照试验66个；叙述性研究共277个；明确诊断标准70篇；提及纳入或排除标准的16篇；明确疗效标准的287篇；107篇文献记录随访；2篇描述有卫生经济学指标；9篇文献提及不良反应。结论：目前迫切需要正确实施随机、隐藏及盲法、安慰剂对照、有公认诊断及疗效评价标准、进行安全性评价、合理设计随访的随机对照试验研究。同时通过文献初步探讨针灸治疗带状疱疹的施治规律是以阿是穴刺络放血拔罐为主。     

合谷穴治疗中枢性面瘫量效规律探讨

以针刺为干预方式的临床随机对照研究与其他临床试验相比有其独特之处,针刺治疗过程的可见性特点使其在实施中更易受到研究者和研究对象主观因素的影响,在本类研究中宜设计空白针刺组对照,面神经麻痹程度分级量表及面部残疾指数问卷表中躯体功能部分较为适合本类研究的疗效评价。本类研究可采用盲法评价,盲法统计作为针刺疗效或量效临床研究的设计原则,并且在研究中应尽量由一位熟悉面瘫症状积分表的研究者对所有研究对象进行评价。以求降低主观因素的影响,提高本类试验结果科学性及可靠性。     

RANDOMIZED CLINICAL TRIALS ON ACUPUNCTURE PUBLISHED IN CHINESE JOURNALS:A SYSTEMATIC LITERATURE REVIEW

Objective: To systematically evaluate the number and quality of randomized clinical trials(RCTs) on acupuncture published in Chinese journals.Methods: We systematically searched the four main electronic Chinese databases(CNKI, VIP, CBM, Wanfang) from their inception in January 2013 to identify RCTs on acupuncture(including manual and electronic acupuncture), to bibliometrically analyze the RCTs, and to assess methodological quality of the RCTs.Results: A total of 7085 RCTs(involving 698540 participants) were published from 1982 to 2013 in Chinese literature.The top three disease systems identified in the included trials were nervous system(39.5%), musculoskeletal system and connective tissue(21.3%), and genitourinary system(6.2%) according to ICD-10.The 7085 acupuncture trials were compared with no treatment(51 trials, 0.7%), sham-acupuncture(62 trials, 0.9%), conventional treatment(728 trials, 10.3%), other traditionalChinese medicine(911 trials, 12.9%), as well as acupuncture plus conventional treatment versus conventional treatment(946 trials, 13.4%), acupuncture plus one treatment versus another treatment(1493 trials, 21.7%), acupuncture plus one treatment versus acupuncture alone(915 trials, 12.9%).In addition, 1135 trials(16.0%) were two-armed RCTs, in which acupuncture applied in both groups.A total of 844 trials(11.9%) were three or more-armed RCTs.Forty-two trials(0.6%) of 7085 RCTs clearly defined primary and secondary outcomes, 6803(96.0%) reported clinical relevant outcomes, 659(9.3%) reported surrogate outcomes, 497(7.0%) reported safety outcomes.For methodological quality, 2658(37.5%) RCTs reported randomization methods, 121(1.7%) reported allocation concealment methods, 141(2.0%) applied blinding, and only 28(0.4%) described sample size calculation.Conclusion: The number of RCTs on acupuncture was substantial and increasing in China, and acupuncture was most frequently applied to nervous, musculoskeletal and connective tissue diseases.However, the methodological quality of the trials is still low.We recommend that the reports of future RCTs on acupuncture will be based on CONSORT and STRCTA.     

针灸治疗中风后抑郁随机对照试验的质量评价

目的:对针灸治疗中风后抑郁的文献进行质量评价。方法:计算机检索Cochrane Liberary(1950～2010)、Elsevier(1950～2010)、PubMed(1950～2010)、Embase(1950～2010)、BMJ(1950～2010)等英文数据库和CMCC(1984～2010)、VIP(1989～2010)、CNKI(1979～2010)、万方(1960～2010)等中文数据库。手工检索部分中医类杂志及有关学术会议论文汇编,全面收集针灸治疗中风后抑郁的随机对照试验,并按照Jadad标准独立评价纳入研究的质量,提取数据并进行评价。结果:共纳10篇文献,共计668例患者。近10余年有大量文献报道关于针刺治疗中风后抑郁的文章,但国内外发表的文献缺乏高质量的文献报道,尚不能客观评价针刺治疗中风后抑郁的疗效。结论:今后需要更多随机、设计严谨的对照试验来证实它的临床疗效。     

Acupuncture for Hot Flashes: A Literature Review of Randomized Controlled Trials Conducted in the Last 10 Years

Objective: To conduct a literature review of randomized controlled trials (RCTs) on the use of acupuncture for hot flashes to analyze the characteristics of each study, draw a conclusion on the advantages and disadvantages of previous studies and provide the suggestions for future studies on the same topic. Methods: We searched English and Chinese databases for the literature published from 2009 to 2019 restricted in the English and Chinese language, and we included RCT using acupuncture as the main observational intervention for hot flashes by the criteria. Results: Twenty studies met our eligibility criteria. All the studies were of high quality and confirmed the clinical efficacy of acupuncture for hot flashes, although they used different controlled interventions. The acupuncture treatment and theory of acupoints selection were relatively consistent among the studies, and they had close trial designs. Conclusions: These RCTs on acupuncture were nonuniform, which made the studies on this topic lack coherence, leading to unsatisfactory research outcomes. Therefore, more professional research teams are needed to perform studies on a definite topic and draw a specific conclusion to previous studies before the next step is taken.     

THERAPEUTIC EFFECTS OF ACUPUNCTURE PLUS FACIAL MUSCLE TRAINING THERAPY IN THE TREATMENT OF INTRACTABLE FACIAL PARALYSIS

Objective: To observe the clinical effect of scalp acupuncture combined with face muscle training on chronic facial paralysis.Methods: Sixty-two patients were randomly divided into two groups for treatment of chronic facial paralysis.Results: The experimental group had 90.63% effective rate including 15 cured, 14 valid and 3 invalid, and the control group had 66.67% effective rate including 8 cured, 12 valid and 10 invalid.The difference of the effective rate in the two groups was statistically significant(P0.05).Conclusion: Scalp acupuncture with face muscle training in treating chronic facial paralysis is clinically effective and should be promoted for its clinical value.