推拿治疗失眠的系统评价
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摘要
目的:系统评价推拿治疗失眠的临床疗效及安全性。方法:计算机检索CNKI、维普、万方、Web of Science、PubMed数据库,查找关于推拿治疗失眠的随机对照试验(RCT)。由两名评价员按照纳入与排除标准,独立筛选文献,并对纳入的文献进行数据提取、质量评估,运用RevMan 5.3进行Meta分析。结果:最终纳入16项随机对照研究,共1005例患者。所有文献均以总有效率及匹兹堡睡眠质量指数(PSQI)总分为结局指标。根据干预措施的不同,进行异质性分组分析。Meta分析结果显示:单纯推拿治疗失眠总有效率(OR=2.17,95%CI[1.40,3.35],P=0.0005),PSQI总分(SMD=-0.57,95%CI[-0.73,-0.42],P<0.00001),提示单纯推拿治疗失眠的疗效优于其它疗法,其差异均有统计学意义;推拿联合针刺治疗失眠总有效率(OR=2.94,95%CI[1.50,5.77],P=0.002),PSQI总分(SMD=-1.16,95%CI[-1.40,-0.92],P<0.00001),提示推拿联合针刺治疗失眠的疗效优于针刺疗法,其差异均有统计学意义。治疗组均未见不良反应等安全性问题。结论:推拿治疗失眠临床疗效确切,且未出现不良反应;由于本研究的局限性,需进一步深入研究推拿治疗失眠,为临床应用提供更可靠的循证依据。
Objective: To systematically review the effectiveness and safety of Tuina in the treatment of insomnia. Methods: CNKI, VIP, WanFang, Web of Science and PubMed database were searched to find the RCTs of the treatment of insomnia. According to the inclusion and exclusion criteria, the two reviewers independently screened the literature and conducted data extraction and quality assessment of the included literatures, then, Meta-analysis was performed by using RevMan 5.3 for Meta analysis. Results: Sixteen RCTs were included, with a total of 1 005 patients. All literatures are based on total efficiency and PSQI total score. According to the different intervention measures, the heterogeneity was analyzed. Meta analysis results showed that pure Tuina therapy total effective rate of insomnia(OR=2.17, 95%CI[1.40, 3.35], P=0.0005), the total scores of PSQI(SMD=-0.57, 95%CI[-0.73,-0.42], P<0.00001), suggesting pure. Tuina curative effect is better than that of other treatments for the treatment of insomnia, the difference had statistical significance. Tuina combined acupuncture treatment insomnia total effectiveness(OR=2.94, 95%CI[1.50, 5.77], P=0.002), the total scores of PSQI(SMD=-1.16, 95%CI[-1.40,-0.92], P<0.00001), suggesting the Tuina combined acupuncture curative effect is superior to the acupuncture treatment of insomnia, the differences were statistically significant. No adverse reactions were observed in the treatment group. Conclusion: The clinical efficacy of Tuina therapy for insomnia is accurate, and there is no adverse reaction. Due to the limitations of this study, it is necessary to further study the Tuina treatment of insomnia, provide more reliable evidence-based basis for clinical application.
Objective: To systematically review the effectiveness and safety of Tuina in the treatment of insomnia. Methods: CNKI, VIP, WanFang, Web of Science and PubMed database were searched to find the RCTs of the treatment of insomnia. According to the inclusion and exclusion criteria, the two reviewers independently screened the literature and conducted data extraction and quality assessment of the included literatures, then, Meta-analysis was performed by using RevMan 5.3 for Meta analysis. Results: Sixteen RCTs were included, with a total of 1 005 patients. All literatures are based on total efficiency and PSQI total score. According to the different intervention measures, the heterogeneity was analyzed. Meta analysis results showed that pure Tuina therapy total effective rate of insomnia(OR=2.17, 95%CI[1.40, 3.35], P=0.0005), the total scores of PSQI(SMD=-0.57, 95%CI[-0.73,-0.42], P<0.00001), suggesting pure. Tuina curative effect is better than that of other treatments for the treatment of insomnia, the difference had statistical significance. Tuina combined acupuncture treatment insomnia total effectiveness(OR=2.94, 95%CI[1.50, 5.77], P=0.002), the total scores of PSQI(SMD=-1.16, 95%CI[-1.40,-0.92], P<0.00001), suggesting the Tuina combined acupuncture curative effect is superior to the acupuncture treatment of insomnia, the differences were statistically significant. No adverse reactions were observed in the treatment group. Conclusion: The clinical efficacy of Tuina therapy for insomnia is accurate, and there is no adverse reaction. Due to the limitations of this study, it is necessary to further study the Tuina treatment of insomnia, provide more reliable evidence-based basis for clinical application.
引文
[1]American Academy of Sleep Medicine.International Classification of Sleep Disorders.3rd ed.Darien,IL:American Academy of Sleep Medicine,2014
[2]刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究.中华精神科杂志,1996,29(2):103-107
[3]于晓彬.“健脾养心安神推拿法”治疗失眠症(心脾两虚型)临床研究.长春:长春中医药大学,2013
[4]刘玥.推拿骶尾部治疗失眠的临床疗效观察.广州:广州中医药大学,2014
[5]卫明,曹仁发,顾非,等.内功一指禅推拿治疗失眠症疗效观察.上海中医药杂志,2013,47(5):60-61
[6]姜丽丽.健脾养心法治疗心脾两虚型失眠的临床研究.济南:山东中医药大学,2009
[7]徐子莉.通督推拿法治疗心脾两虚型失眠的临床研究.济南:山东中医药大学,2012
[8]李正祥,李秀彬,王立新,等.“三才”推拿法治疗心肾不交型失眠症的临床观察.中国中医药科技,2015,22(5):566-567
[9]李莉.引阳入阴推拿法治疗原发性失眠的临床研究.济南:山东中医药大学,2009
[10]罗永宝,陶善平,汪健,等.三部推拿联合耳穴贴压治疗心脾两虚型失眠的临床观察.成都中医药大学学报,2015,38(1):79-81,85
[11]苏日亮.交通心肾推拿法治疗心肾不交型失眠症的临床疗效观察.济南:山东中医药大学,2011
[12]蔡俊萍,张雅丽,黄凤,等.头面部推拿结合气息导引对睡眠障碍影响的临床观察.上海中医药杂志,2013,47(11):54-57
[13]谭涛,王金贵,孙庆.“津沽推拿”之通脉调神手法对心脾两虚型心理生理性失眠患者多导睡眠图总睡眠时间、各期睡眠百分比的影响.辽宁中医杂志,2014,41(9):1811-1814
[14]张奇.针刺结合头颈部推拿治疗阴虚火旺型失眠症的临床观察.武汉:湖北中医药大学,2013
[15]彭春菊.针刺配合背俞穴点穴治疗虚证失眠临床研究.广州:广州中医药大学,2014
[16]石向东,吕瑛,洪春荣,等.针刺联合朱氏一指禅推拿治疗失眠症临床观察.上海针灸杂志,2017,36(10):1203-1206
[17]董勤建,宋春华,李晓艳,等.针刺结合头颈部按摩治疗顽固性失眠24例.针灸临床杂志,2013,29(01):25-27
[18]金惠真.电针结合头部推拿治疗失眠的临床研究.广州:广州中医药大学,2011
[19]中华医学会精神科分会.中国精神障碍分类与诊断标准.3版.济南:山东科学技术出版社,2001:9-168
[20]中华人民共和国卫生部.中药新药临床研究指导原则.北京:人民卫生出版社,1993:186
[21]国家中医药管理局.中医病证诊断疗效标准.南京:南京大学出版社,1994:201
[22]Spielman A J,Caruso L S,Glovinsky P B.A behavioral perspective on insomnia treatment.The Psychiatric clinics of North America,1987,10(4):541-553
[23]姚静静.三部推拿法对心脾两虚型失眠患者多导睡眠图及5-羟色胺的影响.郑州:河南中医学院,2014
[24]周运峰,魏玉龙,张璞,等.三部推拿法治疗心脾两虚型不寐:多中心对照研究.中国针灸,2006,26(6):385-388
[2]刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究.中华精神科杂志,1996,29(2):103-107
[3]于晓彬.“健脾养心安神推拿法”治疗失眠症(心脾两虚型)临床研究.长春:长春中医药大学,2013
[4]刘玥.推拿骶尾部治疗失眠的临床疗效观察.广州:广州中医药大学,2014
[5]卫明,曹仁发,顾非,等.内功一指禅推拿治疗失眠症疗效观察.上海中医药杂志,2013,47(5):60-61
[6]姜丽丽.健脾养心法治疗心脾两虚型失眠的临床研究.济南:山东中医药大学,2009
[7]徐子莉.通督推拿法治疗心脾两虚型失眠的临床研究.济南:山东中医药大学,2012
[8]李正祥,李秀彬,王立新,等.“三才”推拿法治疗心肾不交型失眠症的临床观察.中国中医药科技,2015,22(5):566-567
[9]李莉.引阳入阴推拿法治疗原发性失眠的临床研究.济南:山东中医药大学,2009
[10]罗永宝,陶善平,汪健,等.三部推拿联合耳穴贴压治疗心脾两虚型失眠的临床观察.成都中医药大学学报,2015,38(1):79-81,85
[11]苏日亮.交通心肾推拿法治疗心肾不交型失眠症的临床疗效观察.济南:山东中医药大学,2011
[12]蔡俊萍,张雅丽,黄凤,等.头面部推拿结合气息导引对睡眠障碍影响的临床观察.上海中医药杂志,2013,47(11):54-57
[13]谭涛,王金贵,孙庆.“津沽推拿”之通脉调神手法对心脾两虚型心理生理性失眠患者多导睡眠图总睡眠时间、各期睡眠百分比的影响.辽宁中医杂志,2014,41(9):1811-1814
[14]张奇.针刺结合头颈部推拿治疗阴虚火旺型失眠症的临床观察.武汉:湖北中医药大学,2013
[15]彭春菊.针刺配合背俞穴点穴治疗虚证失眠临床研究.广州:广州中医药大学,2014
[16]石向东,吕瑛,洪春荣,等.针刺联合朱氏一指禅推拿治疗失眠症临床观察.上海针灸杂志,2017,36(10):1203-1206
[17]董勤建,宋春华,李晓艳,等.针刺结合头颈部按摩治疗顽固性失眠24例.针灸临床杂志,2013,29(01):25-27
[18]金惠真.电针结合头部推拿治疗失眠的临床研究.广州:广州中医药大学,2011
[19]中华医学会精神科分会.中国精神障碍分类与诊断标准.3版.济南:山东科学技术出版社,2001:9-168
[20]中华人民共和国卫生部.中药新药临床研究指导原则.北京:人民卫生出版社,1993:186
[21]国家中医药管理局.中医病证诊断疗效标准.南京:南京大学出版社,1994:201
[22]Spielman A J,Caruso L S,Glovinsky P B.A behavioral perspective on insomnia treatment.The Psychiatric clinics of North America,1987,10(4):541-553
[23]姚静静.三部推拿法对心脾两虚型失眠患者多导睡眠图及5-羟色胺的影响.郑州:河南中医学院,2014
[24]周运峰,魏玉龙,张璞,等.三部推拿法治疗心脾两虚型不寐:多中心对照研究.中国针灸,2006,26(6):385-388
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