Zhongguo cuzhong zazhi (Dec 2022)
卒中后吞咽障碍应用耳穴压豆治疗效果的meta分析 The Efficacy of Auricular Acupuncture Pressing for Post-Stroke Dysphagia: A Meta-Analysis
Abstract
目的 评价耳穴压豆在卒中后吞咽障碍患者中的应用效果。 方法 计算机检索PubMed、Web of science、Embase、CINAHL、Cochrane Library、中国知网数据库、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库中关于耳穴压豆应用于卒中后吞咽障碍患者的随机对照试验，检索时限为建库至2022年5月。结局指标包括吞咽功能结局[治疗有效率、标准吞咽功能量表评分（standardized swallowing assessment，SSA）、洼田饮水试验]，生活质量[吞咽相关生存质量量表（swallowing quality of life，SWAL-QOL）]，营养状况（白蛋白水平和营养不良发生率）以及吸入性肺炎发生率。经2名研究者筛选文献、提取信息与质量评价后，采用RevMan 5.3软件进行干预组（耳穴压豆治疗）和对照组的结局指标meta分析。 结果 最终纳入12项研究，共874例患者。分析结果显示，在吞咽功能方面，干预组的治疗有效率（RR 1.25，95%CI 1.16～1.35，P＜0.001）、SSA评分（MD -4.45，95%CI -6.81～-2.10，P＜0.001）、洼田饮水试验（MD -0.99，95%CI -1.11～-0.88，P＜0.001）较对照组改善。在生活质量方面，干预组治疗后的SWAL-QOL得分较对照组提高（MD 15.50，95%CI 4.15～26.85，P=0.007）。在营养状况方面，干预组治疗后的白蛋白水平（MD 4.39，95%CI 0.82～7.97，P=0.020）较对照组升高，营养不良发生率（RR 0.22，95%CI 0.12～0.40，P＜0.001）较对照组降低。另外，干预组吸入性肺炎发生率较对照组降低（RR 0.31，95%CI 0.20～0.50，P＜0.001）。 结论 耳穴压豆可提高卒中后吞咽障碍患者的吞咽功能，改善患者的营养状况，降低其吸入性肺炎的发生率，提高其生活质量。 Abstract: Objective To evaluate the efficacy of auricular acupuncture pressing for post-stroke dysphagia (PSD) through meta-analysis. Methods The randomized controlled trials (RCTs) on auricular acupuncture pressing for treating PSD were retrieved from the databases including PubMed, Web of Science, Embase, CINAHL, Cochrane Library, CNKI, Wanfang, VIP, and CBMdisc from inception to May 2022. The outcome indexes included swallowing outcome [the effective rate, standardized swallowing assessment (SSA), and water swallow test (WST)], life quality [swallowing quality of life (SWAL-QOL)], nutrition condition (albumin level and incidence of malnutrition) and incidence of aspiration pneumonia. Literature screening, data extraction and quality evaluation were performed by 2 researchers, and RevMan 5.3 software was used for meta-analysis. Results A total of 12 RCTs involving 874 patients were included in this meta-analysis. The results showed that after the intervention, the effective rate (RR 1.25, 95%CI 1.16-1.35, P<0.001) , the scores of SSA (MD -4.45, 95%CI -6.81--2.10, P<0.001) and WST (MD -0.99, 95%CI -1.11--0.88, P<0.001) in auricular acupuncture pressing group were better than that in the control group; the score of SWAL-QOL in the intervention group was higher than that in the control group (MD 15.50, 95%CI 4.15-26.85, P=0.007); the albumin level in the intervention group was higher than that in the control group (MD 4.39, 95%CI 0.82-7.97, P=0.020), the incidence of malnutrition was lower than that in the control group (RR 0.22, 95%CI 0.12-0.40, P<0.001); and the incidence of aspiration pneumonia in the intervention group was lower than that in the control group (RR 0.31, 95%CI 0.20-0.50, P<0.001). Conclusions For patients with PSD, auricular acupuncture pressing can improve the swallowing function, quality of life, and nutrition condition of patients, and reduce the incidence of aspiration pneumonia.
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