针灸对神经源性膀胱疗效的系统评价与Meta分析

李月英 王冰 刘悦 王霞 李美

摘要  目的：评价针灸对脊髓损伤后神经源性膀胱的疗效及常用选穴方案。方法：选取Corchorane系统评价方法，系统回顾已有关于针灸治疗脊髓损伤后神经源性膀胱的临床随机对照试验。通过对符合纳入标准的文献质量进行评估并对研究资料进行提取，最终采用RevMan软件进行数据分析。结果：本研究共纳入26篇相关文献，包含1 778例脊髓损伤后神经源性膀胱患者，其中观察组895例，对照组883例。Meta分析结果表明，针灸联合基础治疗对于患者膀胱容量的改善在试验开始1个月（MD=31.86，95%CI=26.63～35.09， P =0.03），2个月（MD=48.51，95%CI=43.33～53.68， P =0.000 2）及3个月时（MD=34.84，95%CI=9.96～59.71， P =0.63）均优于单纯采用基础观察组。针灸联合基础治疗对于患者残余尿量的改善在试验开始1个月（SMD=-1.51，95%CI=-2.09～-0.94， P <0.000 01），2个月（SMD=-1.10，95%CI=-1.51～-0.69， P <0.000 01）及3个月时（SMD=-4.59，95%CI=-6.97～-2.21， P <0.000 01）均优于单纯采用基础觀察组。结论：针灸联合基础治疗对于脊髓损伤后神经源性膀胱的康复明显优于单纯采用基础治疗。

关键词  脊髓损伤;神经源性膀胱;针灸;基础治疗;联合作用;康复;系统评价;Meta分析

System Review and Meta Analysis of Therapeutic Effects of Acupuncture on Neurogenic Bladder

LI Yueying，WANG Bing，LIU Yue，WANG Xia，LI Mei

（First Department of Rehabilitation Medicine，People′s Hospital of Hengshui/Halixun International Peace Hospital，Hengshui 053000，China）

Abstract Objective： To evaluate the therapeutic effects and the commonly used acupoint selection program.of acupuncture on neurogenic bladder after spinal cord injury on the basis of the existing clinical practice evidence  Methods： Based on the method of Corchorane system evaluation，a systematic review of the randomized controlled trials of acupuncture for the treatment of neurogenic bladder after spinal cord injury was conducted.Through the evaluation of the quality of the documents that meet the inclusion criteria and the extraction of the research data，the data analysis was finally carried out using RevMan software. Results： A total of 26 related literatures were included in the study，including 1 778 patients with neurogenic bladder after spinal cord injury，895 in the treatment group and 883 in the control group.The results of Meta-analysis showed that the improvement of bladder capacity in patients with acupuncture combined with basic treatment was 1 month after the start of the trial （MD=31.86，95% CI=26.63～35.09， P =0.03），2 months （MD=48.51，95% CI=43.33～53.68， P =0.000 2） and 3 months （MD=34.84，95% CI=9.96～59.71， P =0.63），which was better than those of the basic treatment group.The improvement of residual urine volume in patients with acupuncture combined with basic treatment in the first month of the trial （SMD=-1.51，95% CI=-2.09～-0.94， P <0.000 01），2 months （SMD=-1.10，95% CI=-1.51～-0.69， P <0.000 01） and 3 months （SMD=-4.59，95% CI=-6.97～-2.21， P <0.000 01） was better than those of the basic treatment group. Conclusion： The existing clinical research evidence indicates that acupuncture combined with basic treatment is better than the basic treatment for the recovery of neurogenic bladder after spinal cord injury.This provides a strong theoretical basis for more rigorous clinical larg e-sample multicenter randomized controlled studies in the future.

Keywords  Spinal cord injury; Neurogenic bladder; Acupuncture; Rehabilitation; Basic therapy; Combined effects; System review; Meta analysis

中图分类号：R245;R247.9 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.011

脊髓损伤（Spinal Cord Injury，SCI）是一种由于脊髓受到严重创伤引起的脊髓传导功能异常，造成损伤平面以下感觉、运动功能部分或完全丧失的一种疾病[1]。在全世界范围内，SCI的发病率为每年3.6～195.4人/百万人[2-5]。而在我国，SCI的发生率每年约为1/10万人[6-7]。该病一旦发生通常会导致呼吸、消化、泌尿及自主神经功能紊乱等全身多器官功能障碍，不仅需要高额的医疗花费，更是会给家庭和社会带来沉重的负担[8-10]。其中，神经源性膀胱是SCI最常见的并发症之一，也是造成脊髓损伤患者死亡的一个重要原因[11-12]。

然而，对于神经源性膀胱的治疗，目前还没有确切有效的治疗方法[13-15]。膀胱功能训练、物理治疗、手术治疗、药物治疗等方法虽然在临床上应用较多，但由于疗效方法疗效大都较为局限，且很多疗法具有潜在的不良反应，因而一直无法得到广泛的认可[16-21]。……