耳穴贴压防治阿片类药物所致便秘的系统评价

[目的]系统评价耳穴贴压防治阿片类药物所致便秘的有效性及安全性,并探讨耳穴贴压防治阿片类药物所致便秘的选穴规律。[方法]计算机检索数据库,中文检索包括中国知网数据库(CNKI)、中国维普数据库(VIP)、中国生物医学数据库(CBM)、万方数据库(WanFang),英文检索PubMed、Embase、The Cochrane library数据库,检索耳穴贴压防治癌痛病人应用阿片类药物所致便秘的随机对照试验(RCT)。[结果]共纳入研究9个,总计870例病人。Meta分析结果显示:耳穴贴压防治癌症病人使用阿片类药物后所致便秘的总有效率优于对照组[OR=4.09,95%CI(2.91,5.75),Z=8.13,P<0.01]。耳穴贴压频次统计5次以上的穴位为大肠、脾、直肠下段、便秘点、三焦。[结论]耳穴贴压可有效防治癌症病人使用阿片类药物后所致便秘,耳穴贴压防治癌症病人使用阿片类药物后所致便秘避免了口服药物产生的肠胃刺激,在安全性上更具优势。其选穴多以大肠、脾、直肠下段、便秘点、三焦为主,以达到通调肠府,刺激肠蠕动的作用。

Systematic review of auricular plaster therapy for prevention and treatment of opioid induced constipation

Objective:To systematically evaluate the effectiveness and safety of auricular plaster therapy to prevent opioid induced constipation,and to explore the rule of acupoint selection for the prevention and treatment of opioid induced constipation.Methods:Randomized controlled trials(RCTs)of auricular plaster therapy for preventing and treating constipation caused by opioids in patients with cancer pain were retrieved from China National Knowledge Infrastructure(CNKI),Chongqing Weipu Database(VIP),China Biomedical Database(CBM),Wanfang Database,PubMed,Embase,and The Cochrane Library.Results:A total of 9 studies were included,involving 870 patients.The results of the meta-analysis showed that the total effective rate of auricular plaster therapy for preventing and treating opioid-induced constipation in cancer patients was better than that in the control group[OR=4.09,95%CI(2.91,5.75),Z=8.13,P<0.01].Ear acupuncture points were counted more than 5 times including the large intestine,spleen,lower rectum,constipation points,and Sanjiao.Conclusions:Auricular plaster therapy could effectively prevent opioid-induced constipation in cancer patients and avoid gastrointestinal irritation caused by oral drugs,which had more advantages in safety.The acupoints were mostly selected from the large intestine,spleen,lower rectum,constipation point,and Sanjiao,in order to achieve the role of regulating intestinal,stimulate the intestinal peristalsis.