[1]范筱,汪今朝,刘宇△.针灸治疗脊髓损伤后神经源性膀胱疗效和安全性的Meta分析[J].中国中医骨伤科杂志,2017,25(09):35-43.
　FAN,Xiao,WANG,et al.Acupuncture for the Effect and Safety of Neurogenic Bladder after Spinal Cord Injury: A Meta-analysis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(09):35-43.
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针灸治疗脊髓损伤后神经源性膀胱疗效和安全性的Meta分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年09期
页码:
35-43
栏目:
文献研究
出版日期:
2017-09-08

文章信息/Info

Title:
Acupuncture for the Effect and Safety of Neurogenic Bladder after Spinal Cord Injury: A Meta-analysis
文章编号:
1005-0205(2017)09-0035-09
作者:
范筱1; 汪今朝1; 刘宇1△
1福建中医药大学(福州,350122) △通信作者 E-mail:511706630@qq.com
Author(s):
FAN; Xiao1; WANG; Jinzhao1; LIU; Yu1△
1Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China.
关键词:
针灸;  脊髓损伤;  神经源性膀胱;  Meta分析
Keywords:
acupuncture;  spinal cord injury;  neurogenic bladder;  Meta analysis
分类号:
R274.39
文献标志码:
A
摘要:
目的:评价针灸治疗脊髓损伤后神经源性膀胱的疗效和安全性,为临床提供指导和依据。方法:计算机检索PubMed,EMBASE,Cochrane临床对照试验注册资料库,中国知网数据库,万方数据库,维普数据库,中国生物医学文献数据库,检索时间自建库至2016年7月,获得与针灸治疗脊髓损伤后神经源性膀胱相关的随机对照试验,应用RevMan5.3 软件进行数据分析,根据纳入研究间的异质性选择相应的效应模型,无法进行数据合并时采用描述性分析。结果:1)与对照组相比,针灸治疗组可显著减少膀胱残留尿量(尿流动力学检测亚组:MD=-36.91,95%CI=-41.08～-32.75,P<0.000 01.B超检测亚组:MD=-27.07,95%CI=-34.48～-19.66,P<0.000 01.导尿法亚组:MD=-25.6,95%CI=-47.24～-3.96,P=0.02)。2)与对照组相比,针灸治疗组可显著增加膀胱最大容量(尿流动力学检测亚组:MD=53.38,95%CI=43.48～63.28,P<0.000 01.B超检测亚组:MD=51.99,95%CI=36.91～67.08,P<0.000 01; 导尿法亚组:MD=36.42,95%CI=-41.28～114.12,P=0.36)。3)与对照组相比,针灸治疗组可增大尿道闭合压(MD=7.04,95%CI=4.92～9.16,P<0.000 1)。4)与对照组相比,针灸治疗组可改善膀胱顺应性(MD=0.89,95%CI=0.53～1.25,P<0.000 1)。5)与对照组相比,针灸治疗组日平均尿失禁次数显著减少(MD=-1.89,95%CI=-2.15～-1.63,P<0.000 1)。6)与对照组相比,针灸治疗组日平均排尿量显著增加(MD=61.37,95%CI=49.57～73.18,P<0.000 1)。7)与对照组相比,针灸治疗组的治疗有效率显著提高(RR=1.48,95%CI=1.31～1.68,P<0.000 1)。8)针灸治疗组不良事件发生率与对照组相比差异无统计学意义(RR=0.37,95%CI=0.1～1.36,P=0.13)。结论:针灸治疗单独应用或针灸治疗作为辅助治疗,联合其他治疗方法治疗脊髓损伤后神经源性膀胱具有一定的有效性和安全性,可减少膀胱残留尿量、日平均尿失禁次数,增大膀胱最大容量、尿道闭合压和日平均排尿量,总体改善膀胱功能。但是,由于纳入研究的质量和证据强度不高,以及纳入研究间的异质性,部分分析结果需谨慎对待,仍需要大量高质量的随机对照试验,以进一步分析得出更准确的结论,为临床治疗提供指导和依据。
Abstract:
bstract Objective:To evaluate the effect and safety of acupuncture for neurogenic bladder after spinal cord injury. Methods:PubMed, EMBASE, Cochrane Central Register of Controlled Trials(CENTRAL), China National Knowledge Infrastructure(CNKI)database, Wanfang database, Chinese Science and Technology Periodical(VIP)database and SinoMed database were retrieved from their inception to July 2016 by computer to obtain relative randomized controlled trials(RCT)about acupuncture for neurogenic bladder after spinal cord injury. RevMan V5.3 software was used to analyze data and effect model was selected in accordance with heterogeneity. Descriptive analysis was used when data consolidation was not possible. Results:1)Compared with controlled group, the residual urine volume was significantly reduced in acupuncture group(Urodynamic determination subgroup: MD=-36.91, 95%CI=-41.08～-32.75, P<0.000 01; B-ultrasound examination subgroup: MD=-27.07, 95%CI=-34.48～-19.66, P<0.000 01; Catheterization group: MD=-25.6, 95%CI=-47.24～-3.96, P=0.02).2)Compared with controlled group, the maximum bladder capacity was significantly enlarged in acupuncture group(Urodynamic determination subgroup: MD=53.38, 95%CI=43.48～63.28, P<0.000 01; B-ultrasound examination subgroup: MD=51.99, 95%CI=36.91～67.08,P<0.000 01; Catheterization group: MD=36.42, 95%CI=-41.28～114.12, P=0.36).3)Compared with controlled group, the urethral closure pressure was significantly increased in acupuncture group(MD=7.04, 95%CI=4.92～9.16,P<0.0001).4)Compared with controlled group, the bladder compliance was significantly ameliorated in acupuncture group(MD=0.89, 95%CI=0.53～1.25,P<0.000 1).5)Compared with controlled group, the daily mean urinary incontinence was significantly decreased in acupuncture group(MD=-1.89, 95%CI=-2.15～-1.63, P<0.000 1).6)Compared with controlled group, the daily mean micturition volume was significantly increased in acupuncture group(MD=61.37, 95%CI=49.57～73.18,P<0.000 1).7)Compared with controlled group, the effective rate was significantly enhanced in acupuncture group(RR=1.48, 95%CI=1.31～1.68, P<0.000 1).8)There was no significant difference in the incidence of adverse events between the acupuncture treatment group and the control group(RR=0.37, 95%CI=0.1～1.36, P=0.13).Conclusion:The present Meta analysis shows that no matter acupuncture mono-therapy or acupuncture combined with other treatment methods has effect on neurogenic bladder after spinal cord injury by the reduce of residual urine volume and daily mean urinary incontinence and the improvement of maximum bladder capacity, urethral closure pressure, bladder compliance, daily mean micturition volume and the effective rate. Meanwhile, without significant incidence of adverse events, acupuncture mono-therapy or acupuncture combined with other treatment methods is safe for the patients of neurogenic bladder after spinal cord injury. However, because of the low quality and evidence of included studies, some analysis results need to be treated with caution. A large number of RCT with high quality are needed to do a further analysis for the more accurate conclusion to provide guideline and basis for clinic therapy.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金资助项目(81503600) 福建省自然科学基金资助项目(2015J01684) 1福建中医药大学(福州,350122) △通信作者 E-mail:511706630@qq.com
更新日期/Last Update: 1900-01-01