按摩对中风后便秘疗效的meta分析

刘跟莉; 唐祎周; 师帅; 刘爽; 韩萌萌; 刘亚

doi:10.16766/j.cnki.issn.1674-4152.002657

按摩对中风后便秘疗效的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.002657

1.
黑龙江中医药大学针灸推拿学院，黑龙江哈尔滨 150001
2.
黑龙江中医药大学附属第二医院针灸科，黑龙江哈尔滨 150001
3.
黑龙江中医药大学附属第二医院康复科
4.
黑龙江中医药大学附属第一医院内分泌科，黑龙江哈尔滨 150040

基金项目:

黑龙江省中医药科研项目 ZHY2020-141

详细信息

通讯作者:
唐祎周，E-mail：26809961@qq.com

中图分类号: R743.3 R256.35 R244.1
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- 文章访问数: 349
- HTML全文浏览量: 146
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-24
- 网络出版日期: 2022-11-29

Efficacy of massage for the treatment of post-stroke constipation: A meta-analysis

1.
College of Acupuncture and Massage, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150001, China

摘要

摘要: 目的旨在评价按摩治疗中风后便秘的临床疗效及其安全性。方法本系统评价遵循系统评价和meta分析的报告规范，通过计算机检索了自数据库建库以来至2020年12月的中英文文献。外文数据库：Cochrane Library、PubMed、EMBASE、Web of Science; 中文数据库：中国生物医学文献数据库(CBM)、万方数据库(Wanfang Data)、维普中文科技期刊数据库(VIP)以及中国期刊全文数据库(CNKI)检索到按摩治疗中风后便秘的相关文献。采用Rev Man 5.3软件进行数据分析。结果最终纳入11篇RCT文献，总计1 045例患者进行meta分析。干预组和对照组之间的总有效率(RR=1.43，95% CI: 1.11~1.83)、便秘发生率(RR=0.36，95% CI: 0.25~0.53)、第2天排便次数(RR=1.98，95% CI: 1.30~3.70)、第3天排便次数(RR=2.27，95% CI: 1.49~3.47)方面比较，干预组均优于对照组。结论按摩治疗可以有效提高中风后便秘的临床疗效，降低中风后便秘的发生率，但还需要多中心、高质量、长期的随机临床研究用以进一步验证。
- 按摩疗法 /
- 慢传输型便秘 /
- 脑血管疾病 /
- Meta分析
Abstract: Objective To evaluate the clinical efficacy and safety of massage in the treatment of constipation after stroke. Methods According to the reporting standards of system evaluation and meta-analysis, Chinese and English literature from the establishment of the database to December 2020 was searched by a computer. Foreign language databases: Cochrane Library, PubMed, Embase, Web of Science, and Chinese databases: China Biomedical Literature Database, Wanfang Data, VIP database and China Journal Full text Database were used to search relevant literature on massage treatment of constipation after stroke. Rev Man 5.3 software was used for data analysis. Results Eleven RCTs with a total of 1 045 patients were included for the meta-analysis. The overall response rate (RR=1.43, 95% CI: 1.11-1.83), incidence of constipation (RR=0.36, 95% CI: 0.25-0.53), frequency of defecation on day 2 (RR=1.98, 95% CI: 1.30-3.70), and frequency of defecation on the third day (RR=2.27, 95% CI: 1.49-3.47) in the intervention group were better than in the control group. Conclusion Massage therapy can effectively improve the clinical efficacy of post-stroke constipation and reduce the incidence of post-stroke constipation, but multi-centre, high quality, long-term randomised clinical studies are needed for further verification.
- Massage /
- Slow transit constipation /
- Cerebrovascular disease /
- Meta-analysis

HTML全文

图 1 文献筛选流程图

Figure 1. Literature screening flow chart

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图 2 偏倚风险的质量评估

Figure 2. Quality assessment of bias risk

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图 3 2组中风患者总有效率比较

Figure 3. Comparison of total effective rate in two groups of stroke patients

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图 4 2组中风患者便秘发生率的比较

Figure 4. Comparison of the incidence of constipation in two groups of stroke patients

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表 1 纳入文献基本特征

Table 1. Basic characteristics of the included literature

第一作者	年份	纳入与排除标准	研究类型	研究对象	干预措施	结果
焦丽敏^[10]	2013	纳入标准：②
		排除标准：⑨⑩	RCT	80/75	腹部脐周按摩和腹部穴位按摩，2次/d，连续3 d	③④
郭敏慧^[11]	2011	纳入标准：②④
		排除标准：⑨	RCT	36/36	腹部穴位按摩，1次/d，连续3 d	①
李华^[12]	2012	纳入标准：②
		排除标准：⑨	RCT	40/40	腹部穴位按摩，1次/d，连续7 d	①
马晓燕^[13]	2017	纳入标准：②
		排除标准：⑨	RCT	36/36	腹部穴位按摩, 2次/d，连续14 d	①
王娜^[14]	2015	纳入标准：②④
		排除标准：⑨	RCT	25/25	腹部穴位按摩, 1次/d，连续21 d	①
钟文^[15]	2017	纳入标准：①②③
		排除标准：⑥⑦⑧	RCT	55/55	腹部经络按摩，1次/d，连续14 d	①
韩利民^[16]	2015	纳入标准：④⑤
		排除标准：⑧⑨	RCT	60/60	腹部按摩，2次/d，连续14 d	②
李天艳^[17]	2008	纳入标准：②
		排除标准：⑨ B12 B13	RCT	31/31	腹部穴位按摩，2次/d，连续14 d	②
左爱文^[18]	2015	纳入标准：②⑤
		排除标准：⑨	RCT	34/34	腹部穴位按摩，1次/d，连续3 d	②③
潘亚兰^[19]	2012	纳入标准：②
		排除标准：⑨	RCT	80/80	腹部穴位按摩，2次/d，连续3 d	③④⑤
王勤丰^[20]	2017	纳入标准：②
		排除标准：⑧⑨	RCT	48/48	腹部穴位按摩，2次/d，连续10 d	②
注：纳入与排除标准中，①研究对象年龄在55~85岁; ②中风的诊断遵循第四届全国脑血管会议的诊断标准，并经CT或MRI证实; ③每周排便次数≤3次，每天粪便质量＜35 g或≥25%的时间患者感到排便费力; ④无吞咽困难; ⑤入院前无习惯性便秘; ⑥智力障碍的患者; ⑦癫痫病; ⑧其他严重疾病; ⑨器质性肠病变; ⑩吞咽功能障碍; ⑪ 节食性便秘; ⑫ 意识障碍; ⑬ 肛门器质性疾病。结果中，①总有效率; ②便秘的发生率; ③首次排便时间; ④首次排便的症状; ⑤血压和心率。临床研究类型RCT为随机对照研究。研究对象为干预组例数与对照组例数。

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表 2 按摩组与对照组中风后排便次数对比的meta数据分析

Table 2. Meta-data analysis of postoperative defecation times between massage group and control group

首次排便时间	纳入文献	样本总量	异质性检验	分析模型	腹部按摩组排便率(%)	对照组排便率(%)	P值
第1天	2	315	I²=0, P=0.912	固定效应模型	11.25(18/160)	14.19(22/155)	0.432
第2天	2	315	I²=36%, P=0.214	固定效应模型	31.88(51/160)	16.13(25/155)	0.012
第3天	2	315	I²=0, P=0.544	固定效应模型	35.00(56/160)	15.48(24/155)	＜0.014

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表 3 敏感性分析结果

Table 3. Results OF sensitivity analyses

评价标准	固定效应模型[RR(95% CI)]	随机效应模型[RR(95% CI)]
总有效率	1.39(1.24, 1.56)	1.43(1.11, 1.83)
便秘发生率	0.37(0.25, 0.55)	0.37(0.25, 0.56)
第1天首次排便时间	0.79(0.44, 1.42)	0.79(0.44, 1.42)
第2天首次排便时间	1.98(1.30, 3.03)	1.96(1.20, 3.20)
第3天首次排便时间	2.27(1.49, 3.47)	2.28(1.49, 3.48)
通便剂的使用	0.38(0.28, 0.52)	0.31(0.08, 1.17)
排便困难	0.68(0.55, 0.85)	0.69(0.55, 0.85)
排便时间延长	0.72(0.59, 0.88)	0.72(0.60, 0.88)
大便干燥	0.60(0.47, 0.77)	0.60(0.47, 0.77)
排便不尽	0.62(0.48, 0.81)	0.63(0.48, 0.82)

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