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针灸推拿联合功能性训练治疗小儿脑瘫运动障碍的Meta分析(PDF)

《云南中医学院学报》[ISSN:1000-2723/CN:53-1048/R]

期数:
2021年01期
页码:
60-67
栏目:
针灸研究
出版日期:
2021-06-28

文章信息/Info

Title:
Acupuncture and Massage Combined with Functional Training in the Treatment of Dyskinesia in Children with Cerebral Palsy: A Meta-analysis
文章编号:
1000-2723(2021)01-0060-08
作者:
颜晓霞1周 锐2姜淑云1△李 阳1俞 艳1鲁潇莹1
(1. 上海中医药大学附属岳阳中西医结合医院,上海200080;2. 广东省中医院,广东 广州 511400)
Author(s):
YAN Xiaoxia1 ZHOU Rui2 JIANG Shuyun1 LI Yang1 YU Yan1 LU Xiaoying1
(1. Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200080, China;2. Guangdong Province Traditional Chinese Medical Hospital, Guangzhou 511400, China)
关键词:
小儿脑瘫针灸推拿运动障碍Meta分析
Keywords:
children with cerebral palsy acupuncture and massage dyskinesia Meta-analysis
分类号:
R246.6
DOI:
10.19288/j.cnki.issn.1000-2723.2021.01.008
文献标识码:
A
摘要:
目的析针灸推拿联合功能性训练和单纯功能性训练治疗小儿脑瘫的临床疗效。方法 收集2005-2020年发表的针灸推拿治疗小儿脑瘫RCT,在PubMed、Embase、Cochrane Library、Ebsco Medline、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(SionMed)全面检索,根据既定标准筛选文献。对纳入研究进行偏倚风险评价;通过I2检验评估研究间的异质性以选择拟合模型后,以儿童神经发育中期(3周岁)为界分亚组进行Meta分析;采用Egger检验检测发表偏倚,运用敏感性分析评估结果的稳定性,并评价结局指标的质量等级。结果 共纳入文献19篇,样本1 812例。联合治疗组为针灸推拿联合功能性训练,训练组为单纯功能性训练。结局指标显示联合治疗组疗效更优。主要结局指标为总有效率:联合治疗组为89.19%,训练组为69.38%,其OR为3.75,95%CI为(2.86,4.92),且两个年龄段的联合治疗组总有效率无明显差异;Barthel指数:SMD=3.16,95%CI(2.91,3.40),P<0.000 1;粗大运动功能测试(GMFM):SMD=1.40,95%CI(1.08,1.73),P<0.000 1,3岁以内联合治疗的康复速度高于3~6岁联合治疗;综合功能评定(FCA):SMD=0.53,95%CI(0.35,0.71),P<0.000 1。Egger检验提示3个结局指标不存在发表偏倚。GRADE证据质量分级显示:总有效率、Barthel指数和FCA为中等级别,GMFM为低级别。结论 针灸推拿联合功能性训练能够提高小儿脑瘫运动障碍治疗疗效,加快康复进程。
Abstract:
Objective To compare the effect of combined therapy and the effect of functional training on children with cerebral palsy. Methods The randomized controlled trials(RCT) published from 2005 to 2020 about the effect of acupuncture and massage combined with functional training on cerebral palsy were recalled from the databases of PubMed, Embase, Cochrane Library, Ebsco Medline, CNKI, Wanfang, VIP, and SinoMed. The methodological quality of the included RCTs was evaluated. The data were extracted, and meta-analyzed with the age boundary of 3 years by RevMan 5.4. The sensitivity analysis and publication bias analysis were in progress with Stata15.0. The classification of evidence was finished with GRADEpro. Results There are 19 Chinese RCTs, involving 1 812 children. The effective rate of the combined therapy group is 89.19% while the effective rate of the functional training group is 69.38%. There is no significant difference between the two age groups. Three secondary indicators show that combined therapy improves the motor ability better: Barthel Index[SMD=3.16, 95%CI(2.91, 3.40), P<0.0001], Gross Motor Function Measure(GMFM)[SMD=1.40, 95%CI (1.08, 1.73), P<0.000 1], Functional Comprehensive Assessment(FCA)[SMD=0.53, 95%CI(0.35, 0.71), P<0.000 1]. Combined therapy improves the GMFM in the first subgroup (within 3 years old) faster than that in the second subgroup (3 to 6 years old). Egger’s analysis shows that there is no publication bias in three indicators. GRADE Evidence Quality Classification shows the effective rate, Barthel Index and FCA are rated as medium level, while GMFM is at a low level. Conclusion The curative effect and the rehabilitation speed of acupuncture and massage combined with functional training for children with cerebral palsy are higher than those of functional training.

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备注/Memo

备注/Memo:
收稿日期: 2020 - 01- 04基金项目: 上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12015130);上海市进一步加快中医药事业发展三年行动计划中医药传承创新平台建设项目(ZY(2018-2020)-CCCX-2004-06)第一作者简介: 颜晓霞(1994-),女,在读硕士研究生,研究方向:儿童发育异常和步态分析。△通信作者: 姜淑云,E-mail:yadancoo@hotmail.com
更新日期/Last Update: 1900-01-01