针灸防治癌因性疲乏临床实践指南研究

车文文 杨静雯 夏小军 姜小燕 王平 潘战宇 王斌 王丹 吕中茜 潘兴芳 陈泽林 郭永明 史丽萍 陈波 郭义

摘要 目的：探索針灸防治癌因性疲乏的临床应用方案，为制定临床实践指南提供依据。方法：通过计算机检索国家知识基础设施数据库（CNKI）、中国学术期刊数据库（CSPD）、中文科技期刊数据库（CCD）、中国生物文献、PubMed、EMBASE、Cochrane Library等数据库，全面收集针灸疗法治疗癌因性疲乏的现代文献证据;通过人工检索49本古代医籍，收集关于针灸疗法治疗疲乏的古代文献证据;通过制定发放《针灸干预癌因性疲乏调查问卷》，收集针灸干预癌因性疲乏的现代一线专家经验。整合3方面证据形成针灸防治癌因性疲乏临床推荐方案。结果：现代文献共检索到225篇，其中中文文献141篇，英文文献84篇，经筛选，最终纳入14篇现代文献;古代医籍文献与之相关的条目共10项;临床专家问卷共收回52份。综合3方面研究结果发现针灸治疗癌因性疲乏常用针刺、艾灸、穴位按压、电针、经皮穴位电刺激等疗法;常用穴位为足三里、三阴交、关元、气海、太溪、合谷、中脘、百会、太冲、印堂、天枢。结论：综合3方面证据，形成针灸防治癌因性疲乏的临床推荐应用方案，强烈推荐使用针刺、艾灸、穴位按压等疗法;弱推荐使用经皮穴位电刺激、电针等疗法;推荐使用穴位为足三里、三阴交、关元、气海、太溪、合谷、中脘、内关、百会、太冲、印堂、天枢、神门等穴。

关键词 针灸;艾灸;穴位按压;癌因性疲乏;临床实践指南;临床方案;证据整合与推荐

Abstract Objective：To explore the clinical application of acupuncture in the prevention and treatment of cancer-related fatigue，and to provide the basis for the development of clinical practice guidelines.Methods：We searched China national knowledge infrastructure（CNKI），China Science Periodical Database（CSPD），Chinese Citation Database（CCD），Chinese Biological Literature，PubMed，EMBASE and Cochrane Library and other databases to comprehensively collect the modern literature evidence of acupuncture treatment of cancer-related fatigue; collected the ancient literature evidence of acupuncture treatment of cancer-related fatigue by manually searching 49 ancient medical books; collected the modern medical experts′ experience of acupuncture intervention of cancer-related fatigue by formulating and distributing the Questionnaire of Acupuncture Intervention On Cancer-Related Fatigue.The 3 aspects of evidence were integrated to form the clinical recommended scheme of acupuncture in the prevention and treatment of cancer-related fatigue.Results：A total of 225 modern literature were retrieved，including 141 Chinese literature and 84 English literature.After sorting out the literature，14 modern literature were finally included; there were 10 items related to ancient medical literature; 52 clinical experts questionnaires were collected.After comprehensive 3 aspects of research results，it was found that acupuncture treatment of cancer-related fatigue commonly used acupuncture，moxibustion，acupoint pressing，electro acupuncture，transcutaneous acupoint electrical stimulation and other therapies; the commonly used acupoints were Zusanli（S36），Sanyinjiao（SP6），Guanyuan（CV4），Qihai（CV6），Taixi（K3），Hegu（L14），Zhongwan（CV12），Baihui（GV20），Taichong（LR3），Yintang（EX-HN3），Tianshu（S25）.Conclusion：Based on the evidence of the 3 aspects，the recommended clinical application scheme of acupuncture for cancer-related fatigue prevention and treatment is formed.Acupuncture，moxibustion and acupoint pressing are strongly recommended; transcutaneous acupoint electrical stimulation and electroacupuncture are weakly recommended; Zusanli（S36），Sanyinjiao（SP6），Guanyuan（CV4），Qihai（CV6），Taixi（K3），Hegu（L14），Zhongwan（CV12），Neiguan（P6），Baihui（GV20），Taichong（LR3），Yintang（EX-HN3），Tianshu（S25），and Shenmen（TF4）etc.are recommended.

Keywords Acupuncture; Moxibustion; Acupressure; Cancer-related fatigue; Clinical practice guidelines; Clinical protocol; Evidence integration and recommendation

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