针刺联合吞咽康复训练预防卒中相关性肺炎的Meta分析

目的系统评价卒中后吞咽障碍患者应用针刺联合吞咽康复训练预防卒中相关性肺炎(SAP)的有效性。 方法电子检索中国期刊全文数据库、万方数据库、维普数据库、Cochrane Library、PubMed共5个数据库,检索日期从建库至2020年6月,根据Cochrane Handbook 5.3评价标准和工具评价纳入研究的质量,并用Revman 5.3软件进行Meta分析。 结果共纳入7篇文献,包括患者520例,试验组261例,对照组259例。Meta分析显示,各研究之间无统计学异质性(P＝0.94,I²＝0%),采用固定效应模型进行分析。所有样本的合并统计量OR值及95%CI为0.28[0.15,0.50],菱形处于中间线的左侧。经Z检验,针刺联合吞咽康复训练SAP发病率明显低于对照组,差异具有统计学意义(Z ＝4.24,P<0.05)。基于特定穴位组合(廉泉、风池、翳风)的亚组分析共纳入3篇文献,包括患者256例,试验组129例,对照组127例。Meta分析显示,各研究之间无统计学异质性(P＝0.67,I²＝0%),采用固定效应模型进行分析。所有样本的合并统计量OR值及95%CI为0.27[0.11,0.62],菱形处于中间线的左侧。经Z检验,试验组和对照组之间SAP的发病率比较,差异具有统计学意义(Z ＝3.08,P<0.05)。 结论与单纯应用吞咽康复训练相比,联合针刺治疗可降低SAP的发病率,具有预防SAP的作用。

Meta-analysis: efficacy of acupuncture combined with swallowing rehabilitation training in the prevention of stroke-related pneumonia

ObjectiveTo evaluate efficacy of acupuncture therapy combined with swallowing rehabilitation training in preventing stroke-associated pneumonia (SAP) in patients with post-stroke dysphagia. MethodsFive databases, including CNKI, Wanfang, VIP, Cochrane Library and PubMed, were searched electronically from the establishment of the database to June 2020. According to the Cochrane Handbook 5.3, the quality of the research included in this study was assessed, and meta-analysis is performed using Revman 5. 3 Software. ResultsA total of 7 articles were selected for inclusion, and there were 520 patients with 261 cases in the trial group and 259 cases in the control group. Meta-analysis showed no statistical heterogeneity between studies (P=0.94, I²=0%), which was analyzed by fixed effect model. The combined OR and 95% CI of all samples were 0.28[0.15, 0.50], and the rhombus was at the left of the median line. Z test showed that incidence of SAP in acupuncture combined with swallowing rehabilitation training was significantly lower than that of the control group, and the difference can reach statistical significance (Z=4.24, P<0.05). Subgroup analysis based on specific acupoint combinations [point CV23 (Lianquan), point GB20(Fengchi) and point TE17(Yifeng)] included 3 literatures, which have 256 patients with 129 in the experimental group and 127 in the control group. Meta-analysis showed no statistical heterogeneity between studies (P=0.67, I²=0%) by using fixed effect model. The combined OR and 95%CI for all samples were 0.27[0.11, 0.62], and the rhombus was to the left of the median line. Z test showed that the incidence difference of SAP between the experimental group and the control group was statistically significant (Z=3.08, P<0.05). ConclusionCompared with swallowing rehabilitation training alone, combined acupuncture treatment can reduce the incidence of pneumonia in patients with dysphagia after stroke, and has the preventive effect of SAP.