针灸对脓毒症疗效与安全性的系统评价

目的系统评价针灸治疗脓毒症患者的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集针灸治疗脓毒症患者的随机对照试验(RCT),检索时限均从建库至2019年10月1日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果纳入20个研究,共1 337例患者。Meta分析结果显示:针灸+常规方法治疗脓毒症患者在28天病死率RR=0.69,95%CI(0.5,0.96),P=0.03]、治疗后第3天APACHEⅡ评分MD=-2.4,95%CI(-3.68,-1.12),P=0.0002]、治疗后第7天APACHEⅡ评分MD=-4.37,95%CI(-6.32,-2.21),P<0.0001]、ICU住院时长MD=-1.54,95%CI(-2.81,-0.27),P=0.02]、胃肠道功能改善有效率RR=1.5,95%CI(1.09,2.06),P=0.01]、治疗后第7天PCT浓度MD=-2.23,95%CI(-3.33,-1.13),P<0.001]和TNF-α浓度MD=-14.86,95%CI(-23.74,-5.97),P=0.001]方面,与常规治疗组的差异均具有统计学意义。但在治疗后第7天CD8^+记数MD=1.65,95%CI(-0.32,3.62),P=0.1]方面,二者差异无统计学意义。结论现有有限证据表明,针灸可能是潜在的治疗脓毒症患者的方法之一。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Efficacy and safety of acupuncture on sepsis: a systematic review

Objectives To systematic review the efficacy and safety of acupuncture on patients with sepsis.Methods The PubMed,EMbase,The Cochrane Library,CNKI,WanFang Data,VIP and CBM databases were searched.The retrieval time was from inception to October 1st,2019.Randomized controlled trials(RCTs)on acupuncture on sepsis were screened.Two researchers independently screened articles,extracted and analyzed data,and evaluated risk of bias included in the study.Meta-analysis was performed by RevMan 5.3 software.Results A total of 20 RCTs involving 1337 patients were included.Meta-analysis showed that there were significant differences between the acupuncture group with conventional treatment in 28-day mortalityRR=0.69,95%CI(0.5,0.9),P=0.03],APACHEⅡscore at 3rd dayMD=-2.4,95%CI(-3.68,-1.12),P=0.0002]and 7thdayMD=-4.37,95%CI(-6.32,-2.21),P<0.0001],length of the ICU stayMD=-1.54,95%CI(-2.81,-0.27),P=0.02],the effective rate for improved gastrointestinal functionRR=1.5,95%CI(1.09,2.06),P=0.01],concentrations of PCTMD=-2.23,95%CI(-3.33,-1.13),P<0.001]and TNF-αMD=-14.86,95%CI(-23.74,-5.97),P=0.001]at the 7thday.However,there was no significant difference between two groups on the CD8+count at the 7thdayMD=1.65,95%CI(-0.32,3.62),P=0.1].Conclusions Available evidence suggests that acupuncture may be a potential treatment method for sepsis patients.Due to limited quantity and quality of included studios,the above conclusions are required to be verified by more high-quality studies.