CAJ | 학술논문

目的：系统评价针灸联合认知康复训练治疗脑卒中后认知障碍的疗效。方法计算机检索CNKI、CBM、VIP、WANFANG DATA和Pubmed、Cochrane Library,查找有关应用针灸联合认知康复训练治疗脑卒中后认知障碍的随机对照试验(RCT),并追索纳入文献的参考文献,检索时限均为1990年1月1日至2015年1月1日。由2名评价者独立选择试验、提取资料和评估方法学质量后,采用RevMan5.3软件进行Meta分析。结果最终纳入11个研究,共789例受试者。Meta分析结果显示,针灸联合认知康复训练在以下方面均优于单纯认知康复训练或药物,且差异有统计学意义,总有效率[RR=1.58,95%CI (1.10,2.26),P=0.01],MMSE 评分[MD=2.64,95%CI(1.78,3.50),P＜0.00001],P300潜伏期[MD=﹣18.46,95%CI(﹣30.51,﹣6.41),P=0.003],P300波幅[MD=1.23,95%CI(0.82,1.63),P＜0.00001],日常生活能力ADL[SMD=0.52,95%CI(0.31,0.73),P＜0.00001]。基于系统评价结果,采用GRADE系统推荐分级方法评价证据质量,结果显示,证据水平均为低级,推荐强度为弱推荐。结论本Meta分析结果提示,针灸联合认知康复训练疗效优于单纯认知康复训练或药物。但由于原始文献质量均较低,尚需要高质量、多中心、大样本的随机盲法对照试验加以证实。
목적：계통평개침구연합인지강복훈련치료뇌졸중후인지장애적료효。방법계산궤검색CNKI、CBM、VIP、WANFANG DATA화Pubmed、Cochrane Library,사조유관응용침구연합인지강복훈련치료뇌졸중후인지장애적수궤대조시험(RCT),병추색납입문헌적삼고문헌,검색시한균위1990년1월1일지2015년1월1일。유2명평개자독립선택시험、제취자료화평고방법학질량후,채용RevMan5.3연건진행Meta분석。결과최종납입11개연구,공789례수시자。Meta분석결과현시,침구연합인지강복훈련재이하방면균우우단순인지강복훈련혹약물,차차이유통계학의의,총유효솔[RR=1.58,95%CI (1.10,2.26),P=0.01],MMSE 평분[MD=2.64,95%CI(1.78,3.50),P＜0.00001],P300잠복기[MD=﹣18.46,95%CI(﹣30.51,﹣6.41),P=0.003],P300파폭[MD=1.23,95%CI(0.82,1.63),P＜0.00001],일상생활능력ADL[SMD=0.52,95%CI(0.31,0.73),P＜0.00001]。기우계통평개결과,채용GRADE계통추천분급방법평개증거질량,결과현시,증거수평균위저급,추천강도위약추천。결론본Meta분석결과제시,침구연합인지강복훈련료효우우단순인지강복훈련혹약물。단유우원시문헌질량균교저,상수요고질량、다중심、대양본적수궤맹법대조시험가이증실。
ObjectiveTo systematically assess the efficacy of acupuncture and moxibustion plus cognitive rehabilitation training in treating post-stroke cognitive disorder.MethodA computer searched CNKI, CBM, VIP, WANFANG DATA, and Pubmed and Cochrane Library for randomized controlled trials (RCT) of acupuncture and moxibustion plus cognitive rehabilitation training for the treatment of post-stroke cognitive disorder. The reference literature in the included literature was also retrieved. Retrieval time limit for both of them was from Jan. 1st 1990 to Jan. 1st 2015. Two reviewers independently selected the trials, extracted the data and assessed the quality of methodology. Meta analysis was then performed using RevMan 5.3 software.ResultEleven trials with a total of 789 subjectswere finally included. The results of Meta analysis showed that the following aspects were better in acupuncture plus cognitive rehabilitation training than in cognitive rehabilitation training or medication alone and there were statistically significant differences: the total efficacy rate [RR=1.58, 95%CI(1.10,2.26),P=0.01], the MMSE score [MD=2.64, 95%CI(1.78, 3.50),P<0.00001], P300 latency [MD=﹣18.46, 95%CI(﹣30.51,﹣6.41),P=0.003], P300 amplitude [MD=1.23, 95%CI(0.82, 1.63),P<0.00001] and activities of daily living (ADL) [SMD=0.52, 95% CI(0.31, 0.73),P<0.00001]. Based on the results of a systematical review, thequality of evidence was assessed using GRADE system recommended classification method. The results showed that the level of evidence was low and the strength of recommendations was weak.ConclusionThe results of Meta analysis showed that the therapeuticeffect was better in acupuncture and moxibustion plus cognitive rehabilitation training than in cognitive rehabilitation training or medication alone. Because of low quality of all the original literature, high-quality, multicenter and large-sample randomized blind controlled trials are still needed for validation.