摘要
目的通过文献定量学分析探讨电针疗法及其不同治疗参数对于尿失禁女性症状的改善和生活质量提高方面的影响。方法通过对中英文8大数据库PubMed、Cochrane library、Web of Science、Embase、中国知网(CNKI)、万方数据库(Wanfang)、重庆维普数据库(VIP)以及中国生物医学文献服务数据库(SinoMed)的检索,根据本研究纳排标准纳入文献,并进行文献风险偏倚评估。使用Stata15.1软件对所纳入研究的各项数据合并分析,评估电针疗法治疗女性尿失禁的临床疗效,并且通过5个亚组的亚组分析(尿失禁类型、选穴、对照组、电针仪波形、疗程5个方面),探讨可能的电针疗法优势参数。结果电针疗法对于改善女性尿失禁患者的生活质量、减少漏尿量及漏尿频率、延长憋尿时间等方面均有优势治疗作用,且疗效优于临床中其他治疗方法。在电针治疗优势参数的选择方面,电针疗法对于压力性女性尿失禁患者具有明显优势的治疗效果,但电针疗法在治疗混合性尿失禁方面的优势仍需更多临床证据。临床中穴位的选择可能以会阳、中髎穴为治疗优势穴位,电针仪波形中连续波效果更佳,且6周左右的疗程可能成为优势疗程选择。讨论纳入的13项研究在实验组干预方式和研究对象一致性高,并且风险偏倚等级较小保证了整体模型的稳定性,并且治疗穴位、疗程、对照组方面具备亚组分析的多元性。结果提示电针疗法对于女性尿失禁患者生活质量的提高、憋尿时间的延长、漏尿量和漏尿频率的减少比其他疗法可能促进作用,但不良事件发生率均有发生,临床中应根据患者症状差异确定治疗方案。整体模型不一致性高并且可能存在发表偏倚,这与纳入研究数量少以及没有限制对照组、选穴、疗程等因素有关。这也提示需要更多的高质量临床研究的报道,从而保证Meta分析的证据质量。亚组分析结果从宏观角度确立不同亚组模型,从而达到不同治疗参数疗效对比,但不能避免模型合并研究数过少、异质性大以及发表偏倚问题,但确实和临床预期有一致性,可进一步研究。
Objective The purpose of this study is to explore the effects of electroacupuncture and its different treatment parameters on the improvement of symptoms and life quality in female urinary incontinence.Methods We searched eight Chinese and English databases(PubMed,Cochrane Library,web of science,EMBASE,CNKI,Wanfang,VIP,and SinoMed),and the literature was included according to the inclusion criteria of this study,and the risk bias was evaluated.We used stata15.1 software to combine and analyze all the data,to evaluate the clinical efficacy of electroacupuncture in the treatment of female urinary incontinence,and to discuss the advantageous treatment parameters of electroacupuncture through the subgroup analysis of five subgroups(urinary incontinence type,acupoint selection,control group,electroacupuncture waveform and course of treatment).Results Electroacupuncture has advantages in improving life quality,reducing the amount and frequency of urinary leakage,and prolonging the time of holding urine for female urinary incontinence patients.The curative effect of electroacupuncture is better than other clinical treatment methods.In terms of the selection of advantageous parameters of electroacupuncture,it has obvious advantages in the treatment of stress female urinary incontinence,but the effect in the treatment of mixed urinary incontinence still needs more clinical evidence.In clinical,Huiyang and Zhongli acupoints may be the better effect acupoints,and the effect of the continuous wave is better.The course of treatment of about 6 weeks may become the choice of the dominant course of treatment.Discussion The 13 studies included in the study had high consistency in the intervention mode and the research object,and the risk bias level was small.which ensured the stability of the overall model.The treatment points,treatment courses,and control group had a diversity of subgroup analyses.The results suggested that electroacupuncture therapy might promote the improvement of the quality of life,the prolongation of the duration of holding urine,and the reduction of the volume and frequency of urine leakage in female patients with urinary incontinence than other therapies.But the incidence of adverse events had occurred.In clinical practice,the treatment plan should be determined according to the differences in symptoms of patients.The overall model was highly inconsistent and might have publication bias,which related to the small number of included studies and the lack of restrictions on the control group,acupoint selection,treatment course,and other factors.This also suggests that more high-quality clinical research reports are needed to ensure the quality of evidence of meta-analysis.The results of subgroup analysis establish different subgroup models from a macro perspective to achieve the efficacy comparison of different treatment parameters.However,it could not avoid the problems of too few combined studies,large heterogeneity,and publication bias,but it was consistent with clinical expectations,which could be further studied.
作者
杨欣铭
冉大为
孔颖
石维平
周佳晓
高华嵩
韩雨橦
张慧雪
石磊
Yang Xinming;Ran Dawei;Kong Ying;Shi Weiping;Zhou Jiaxiao;Gao Huasong;Han Yutong;Zhang Huixue;Shi Lei(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China;National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)
出处
《世界科学技术-中医药现代化》
CSCD
北大核心
2023年第2期659-671,共13页
Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology
基金
国家中医药管理局中医药循证能力建设项目(2019XZZX-ZJ013):针灸治疗优势病的循证研究,负责人:石磊
关键词
电针
女性尿失禁
漏尿
文献定量学分析
Meta分析
电针优势治疗参数
Electroacupuncture
Woman urinary incontinence
Urine leakage
Quantitative analysis of literature
Meta-analysis
Superior therapeutic parameters
作者简介
通讯作者:石磊,副主任医师,医学博士,主要研究方向:针灸临床和治疗机制研究工作。
