神经肌肉电刺激与经皮神经电刺激治疗慢性腰背痛

为探讨电刺激治疗慢性腰背痛的效果,应用双盲的随机的重复测量的设计,比较神经肌肉电刺激(NMES)、经皮神经电刺激(TENS)、NMES与TENS综合及安慰治疗的作用。研究结果提示:综合治疗不仅在疼痛减轻或疼痛缓解方面都比安慰治疗显著有效,而且也比单用TENS或NMES显著有效。此外,为评价长期应用TENS、NMES和综合治疗的作用及副作用,必须随访观察包括疼痛、精神状况和功能在内的临床征候的变化。     

经皮胫神经电刺激治疗神经源性膀胱功能障碍的系统评价

目的:系统评价经皮胫神经电刺激治疗中枢神经系统损伤后神经源性膀胱的效果。方法:计算机检索Pubmed、Cochrane Library、Embase、中国知网(CNKI)、维普数据库、万方数据库,检索年限从建库到2017年7月。有两名评价员独立进行资料筛选,数据提取和文献质量评价。采用RevMan 5.3软件进行Meta分析。结果:共提取文献16篇,共589例。Meta分析结果显示:最大膀胱容量显著增加[MD=86.89,(95%CI:76.60,97.19),P0.01];最大尿流率显著增加[MD=3.98,(95%CI:0.94,7.02),P=0.01];膀胱逼尿肌压力显著下降[MD=-11.11,(95%CI:-18.28,-3.95),P=0.002];最大尿流率时膀胱逼尿肌压力显著下降[MD=-9.32,(95%CI:-12.89,-5.74)。结论:经皮胫神经电刺激可在一定程度上改善神经源性膀胱状态,提升患者生存质量,但仍需高质量大样本的临床试验进一步证明。     

经皮电神经刺激配合微波治疗痛性糖尿病周围神经病变疗效观察

目的:观察经皮电神经刺激(TENS)配合微波治疗痛性糖尿病周围神经病变的效果,制定出痛性糖尿病周围神经病变(PDN)的康复治疗模式.方法:将61例痛性糖尿病周围神经病变患者随机分为治疗组(30例)与对照组(31例),两组患者均接受常规糖尿病治疗,另外实验组给予TENS配合微波治疗.在治疗前和治疗1个疗程(15d)后,分别对两组患者进行问卷调查、定量感觉阈值、神经传导速度的评定,并随访观察预后及进行疗效评价.结果:TENS配合微波治疗痛性糖尿病周围神经病变的治疗组与对照组相比,经随访的问卷调查,治疗组患者对四肢末梢神经的感觉异常恢复满意度及疼痛改善程度显著高于对照组;两组间比较,治愈率治疗组(26.7％)优于对照组(9.6％)(P＜0.05),总有效率治疗组(93.3％)优于对照组(48.3％)(P＜0.05).结论:TENS配合微波治疗,能有效治疗痛性糖尿病周围神经病变,用此疗法比患者单纯药物治疗疗效显著.     

经皮电神经刺激仪治疗三叉神经痛的疗效观察

经皮电神经刺激仪(transcutaneous electrical nerve stimulation，TENS)在国内、外被广泛用于各种慢性疼痛的治疗，尤其在欧美，TENS常做为治疗各种慢性疼痛的第一步治疗措施。目前治疗三叉神经痛的方法不少，但真正令人满意的手段不多。我们使用TENS治疗三叉神经痛患者85例，取得较好效果，报告如下。     

经皮神经电刺激(TENS)的研究新进展

经皮神经电刺激（transcutaneous electrical nerve stimulation，TENS）自1967年首次报道，30多年来已用于临床诸多领域。但国内外对其随机对照的临床研究仍较少，现将近十年来对TENS的研究新进展综述。     

糖尿病性周围神经病的神经传导速度测定与临床研究

目的:探讨神经传导速度(NCV)与糖尿病周围神经病(DPN)的临床相关因素的关系。方法:检测164例糖尿病患者(DM组)和40名健康人(对照组)NCV,并分析其与年龄、病程、血糖、血脂及临床表现的关系。结果:DM组NCV明显低于对照组,DM组中NCV与空腹血糖、血脂无明显相关,与年龄、病程相关,且有周围神经症状者更为明显。结论:NCV的检测有助于DPN的早期诊断。     

外周神经减压术治疗糖尿病性周围神经病的护理

糖尿病性周围神经病是糖尿病最常见的慢性并发症，其发病率高达60％～90％，可以引发多种不同的神经病，其中最常见的是影响足部及手部，主要以四肢麻木、疼痛及感觉异常为主，有些患者会出现下肢溃疡甚至导致截肢，影响了患者的生活质量。外周神经减压术是治疗糖尿病性周围神经病的一种特效方法。可以通过手术减压缓解并达到恢复患者手足感觉及减轻疼痛的目的。     

神经肌肉电刺激同步经皮神经电刺激治疗神经根型颈椎病的疗效观察

目的：观察神经肌肉电刺激（NMES）同步经皮神经电刺激（TENS）对神经根型颈椎病的疗效。方法：72例符合入组条件的神经根型颈椎病（CSR）患者,按Excel产生的随机数字随机分成3组：NMES组（n=24）、TENS组（n=24）、同步组（n=24）。NMES组予颈肩部NMES治疗同步麻木侧上肢安慰TENS治疗;TENS组予颈肩部安慰NMES治疗同步麻木侧上肢TENS治疗;同步组予颈肩部NMES治疗同步麻木侧上肢TENS治疗。每天1次,每次20min,连续治疗14天。分别在治疗前、治疗7次、14次及1个月后比较田中靖久颈椎病症状量表评分（TZCS）、颈椎功能障碍指数（NDI）评分及正中神经和尺神经F波传导速度、生活质量（SF-36）,并观察14次治疗后的痊愈率和总有效率。结果：3组治疗前各项评分结果无显著性差异（P>0.05）。14次治疗后,同步组痊愈率69.57%,高于NMES组（40.91%）、TENS组（34.78%）(P<0.0167)。在TZCS、NDI、神经传导功能、生活质量（SF-36）评分方面,第14次治疗后即刻及治疗后1个月随访时同步组优于NMES组、T...     

经皮神经电刺激并超短波治疗偏瘫肩痛

目的：探讨经皮神经电刺激并超短波治疗偏瘫肩痛的疗效。方法：72例偏瘫肩痛患者随机分为2组，电刺激组36例，采用经皮神经电刺激（TENS）并超短波治疗；超短波组36例，接受单纯超短波治疗。结果：治疗20 d后，电刺激组肩痛程度明显减低,上肢运动功能达〉4级由27.7%提高到66.6%，有效率明显优于超短波组（P〈0.01）。结论：TENS并超短波治疗能显著提高偏瘫肩痛的临床效果。     

Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials

Previous studies and meta-analyses of the efficacy of electrical nerve stimulation (ENS) for the treatment of chronic pain of multiple etiologies have produced mixed results. The objective of the present study was to determine whether ENS is an effective treatment for chronic musculoskeletal pain by using statistical techniques that permit accumulation of a sample size with adequate power. Randomized, controlled trials published between January 1976 and November 2006 were obtained from the National Libraries of Medicine, EMBASE, and the Cochrane Library. Prospective, placebo-controlled studies using any modality of ENS to treat chronic musculoskeletal pain in any anatomical location were included. The main outcome measure was pain at rest. The use of statistical methods to enhance data extraction and a random-effects meta-analysis to accommodate heterogeneity of ENS therapies permitted an adequate number of well designed trials of ENS to be included in the meta-analysis. A total of 38 studies in 29 papers, which included 335 placebo, 474 ENS, and 418 cross-over (both placebo and at least one ENS treatment) patients, met the selection criteria. The overall results showed a significant decrease in pain with ENS therapy using a random-effects model (p<0.0005). These results indicate that ENS is an effective treatment modality for chronic musculoskeletal pain and that previous, equivocal results may have been due to underpowered studies.     

Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain

A double-blind controlled analgesic study was undertaken in outpatients suffering acute traumatic pain. One hundred patients completed the study and were randomly assigned to four treatment groups, each receiving either functioning transcutaneous electrical nerve stimulators (TENS), placebo TENS, acetaminophen with codeine and a functioning TENS, or acetaminophen with codeine and a placebo TENS. Pain was assessed prior to treatment, at 48 hours, and at one month using a visual analog scale. A statistically significant difference in pain relief occurred between the placebo and functioning TENS groups. The TENS was approximately as effective as acetaminophen (300-600 mg) with codeine (30-60 mg) but had no side effects. Transcutaneous electrical nerve stimulators have been shown to be effective in the management of acute traumatic pain and may be indicated for patients who cannot be given medications.     

负压伤口治疗糖尿病足溃疡的系统评价

目的系统评价负压伤口治疗糖尿病足溃疡的有效性和安全性。方法制定严格纳入和排除标准,计算机检索Cochrane图书馆临床对照试验数据库(2011年第1期)、MEDLINE(1978～2011年)、EMBASE(1978～2011年)、OVID数据库(1978～2011年)、中国生物医学文献数据库(CBM-Disc)(1978～2011年)、维普中文期刊数据库(1989～2011年)、中国期刊全文数据库(1979～2011年)、万方学位论文数据库(1978～2011年),并手工检索相关会议论文集及查阅检索到的所有文献的参考文献,全面收集全世界关于负压伤口治疗糖尿病足溃疡的随机对照试验。按照国际Cochrane协作网推荐的方法进行系统评价。结果共纳入8个试验包括628例患者。Meta分析显示:(1)糖尿病足溃疡愈合率、糖尿病足溃疡面积减少、糖尿病足溃疡愈合时间、糖尿病足溃疡第二次截肢率:负压伤口治疗优于常规治疗(OR=2.00,95%CI1.39～2.07,P=0.0002;WMD=8.02,95%CI3.35～12.69,P=0.0008;WMD=-13.99,95%CI-22.26～-5.60,P=0.001;OR=0.33,95%CI0.15～0.71,P=0.005)。(2)副作用及并发症发生率:负压伤口治疗与常规治疗无明显差异,负压伤口治疗组无明显严重治疗相关副作用及并发症的发生,仅2篇试验报道了负压伤口治疗疼痛及出血的发生。结论目前的证据表明,负压伤口治疗糖尿病足溃疡有较好的疗效和安全性,但仍需大量循证医学证据的进一步积累,从而指导临床实践。     

Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials

OBJECTIVE: To assess the efficacy of Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection. METHODS: Systematic review of the literature and meta-analysis of randomized controlled trials. Mean difference in the reduction in symptom severity scores between treatment and control groups was calculated to obtain an overall estimate of effect. RESULTS: Four studies met our inclusion criteria and were reviewed. A total of 433 patients reported in three trials were included in the statistical analysis. Andrographis paniculata fixed combination with Acanthopanax senticosus was more effective than placebo. The mean difference was 2.13 points (95% CI 1.00-3.26 points, P=0.0002) on the symptom severity score. The difference in effects between A. paniculata and placebo was 10.85 points (95% CI 10.36-11.34 points, P<0.0001) in favour of A. paniculata. CONCLUSION: Current evidence suggests that A. paniculata extract alone or in combination with A. senticosus extract may be more effective than placebo and may be an appropriate alternative treatment of uncomplicated acute upper respiratory tract infection.     

Acupuncture for treating diabetic retinopathy: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThis review aimed to examine the effectiveness of acupuncture for the treatment of diabetic retinopathy (DR).MethodsFourteen databases (5 English, 4 Chinese, and 5 Korean) were searched from their inception until May 20, 2020. Randomized controlled trials (RCTs) using acupuncture for DR treatment were included. The study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias tool version 2 (RoB 2.0) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to assess all the included RCTs.ResultsOf 864 citations, 6 RCTs met the inclusion criteria of our review. Four studies reported the beneficial effects of acupuncture with standard medication or acupuncture alone compared with standard medication or no treatment on the effective rate. Only three studies showed that acupuncture combined with standard medications significantly improved visual acuity compared to standard medication alone. None of the studies reported on adverse events. The risk of bias of the included studies was judged to be of “some concern” and was marked with a moderate and low certainty of evidence in different outcomes.ConclusionOur results suggest the potential benefit of acupuncture in treating DR. Acupuncture in the form of combined therapy with standard medication or acupuncture alone may be more effective in the treatment of DR than standard medication alone. Further rigorous clinical trials are needed to confirm these findings.     

Acupuncture for recurrent headaches: a systematic review of randomized controlled trials

Objective : To assess whether there is evidence that acupuncture is effective in the treatment of recurrent headaches. Design :Systematic review. Study selection :Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of recurrent headaches. Data sources : Electronic databases (Medline, Embase, Cochrane Field for Complementary Medicine, Cochrane Controlled Trials Register), personal communications and bibliographies. Data collection and analysis : Information on patients, interventions, methods, and results were extracted by at least two independent reviewers using a pretested form. A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group) was calculated as a crude indicator of trial results as meta-analysis of more specific outcome data was impossible due to heterogeneity and insufficient reporting. Results :Twenty-two trials, including a total of 1042 patients (median 36, range 10–150), met the inclusion criteria. Fifteen trials were in migraine patients, six in tension-headache patients, and in one trial patients with various headaches were included. The majority of the 14 trials comparing true and sham acupuncture showed at least a trend in favor of true acupuncture. The pooled responder rate ratio was 1.53 (95% confidence interval 1.11 to 2.11). The eight trials comparing acupuncture and other treatment forms had contradictory results. Conclusions :Overall, the existing evidence suggests that acupuncture has a role in the treatment of recurrent headaches. However, the quality and amount of evidence is not fully convincing. There is urgent need for well-planned, large-scale studies to assess effectiveness and efficiency of acupuncture under real life conditions.     

Transcutaneous electrical nerve stimulation for postlaparotomy pain

This study was designed to evaluate the transcutaneous electrical nerve stimulation (TENS) postoperative program administered by a physical therapy department. A surgeon, a physical therapist, a recovery room nurse, and unit nurses participated in the program which included preoperative evaluation and patient education, application of sterile electrodes parallel to the incision in the operating room, TENS activation in the recovery room, follow-up visits, and data collection. Seventy-five patients who underwent laparotomy and received TENS at the most comfortable machine settings were compared by chart review to 75 patients who had undergone similar surgical procedures performed by the same surgeon before TENS postoperative pain management had been instituted. The TENS was applied for an average of five days; machine settings of intensity, frequency, and pulse width tended to be midrange. The TENS group took significantly less pain medication, but the length of hospital stay was not significantly different. Patients with TENS rated their pain on 10-point scales as more intense than uncomfortable. This study demonstrated that a well-structured interdisciplinary program of postoperative TENS management can reduce the amount of pain medication taken by patients after laparotomy.