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主题:【原创】看看针灸的临床研究结果 -- 虽远必诛

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家园 接上文翻译

同时这段解释也确实说明国内科研的现状

Our search for eligible reports was nearly comprehensive,

resulting in the identification of 33 RCTs—more

than twice as many as included in any previous review on

this topic. Because of resource limitations, we did not

search Chinese databases. This may have deflated our estimates

of effects because acupuncture RCTs published in

China have been shown to be positive in 100% of all cases

(60). The comprehensiveness of our searches (with the exception

of Chinese databases) might be expected to limit

the effects of publication bias.

我们对于符合条件的文献的搜索近乎全面,得到了33个确定的RCT--几乎是以前这个领域的综述的两倍。由于资源限制,我们并没有搜索中文数据库。这个可能会缩小(或减弱)我们对于针灸RCT的效果判断,因为在中文期刊中发表的有关针灸的RCT中,正面效果在所有的60篇文章中都是100%。 我们全面的搜索(出去中文数据库外)或许可以消除出版物的倾向带来的误导效果。

2,针灸对术后恶心呕吐:

Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting链接出处

有效,但是不必止吐药好。

我专门去看了原文的摘要,现转贴如下

Background

Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004.

Objectives

To determine the efficacy and safety of P6 acupoint stimulation in preventing PONV.

Search strategy

We searched CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), the National Library of Medicine publication list of acupuncture studies, and reference lists of articles.

Selection criteria

All randomized trials of techniques that stimulated the P6 acupoint compared with sham treatment or drug therapy for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, an acu-stimulation device, and acupressure in patients undergoing surgery. Primary outcomes were the risks of nausea and vomiting. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.

Data collection and analysis

Two review authors independently assessed trial quality and extracted the data. We collected adverse effect information from the trials. We used a random-effects model and reported relative risk (RR) with associated 95% confidence intervals (95% CI).

Main results

We included 40 trials involving 4858 participants; four trials reported adequate allocation concealment. Twelve trials did not report all outcomes. Compared with sham treatment P6 acupoint stimulation significantly reduced: nausea (RR 0.71, 95% CI 0.61 to 0.83); vomiting (RR 0.70, 95% CI 0.59 to 0.83), and the need for rescue antiemetics (RR 0.69, 95% CI 0.57 to 0.83). Heterogeneity among trials was moderate. There was no clear difference in the effectiveness of P6 acupoint stimulation for adults and children; or for invasive and noninvasive acupoint stimulation. There was no evidence of difference between P6 acupoint stimulation and antiemetic drugs in the risk of nausea (RR 0.82, 95% CI 0.60 to 1.13), vomiting (RR 1.01, 95% CI 0.77 to 1.31), or the need for rescue antiemetics (RR 0.82, 95% CI 0.59 to 1.13). The side effects associated with P6 acupoint stimulation were minor. There was no evidence of publication bias from contour-enhanced funnel plots.

Authors' conclusions

P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.

我的翻译如下:

背景:

术后恶心以及呕吐(PONV)在外科手术以及麻醉后是常见的复杂因素(或者症状?)药物预防PONV只是部分有效。一种替代疗法是刺激位于手腕上的P6穴位。这篇综述是对于2004年发表在Cochrane上的第一综述的更新。

目标:

判段 P6穴道刺激预防PONV的效果以及安全性。

搜索策略

我们搜索了CENTRAL (The Cochrane Library, Issue 3, 2008), MEDLINE (January 1966 to September 2008), EMBASE (January 1988 to September 2008), ISI Web of Science (January 1965 to September 2008), 国家图书馆药物刊物部分关于针灸的研究,以及这些文章的引文列表。

数据采集和分析

所有的有关于刺激P6穴位相对于安慰疗法或者药物治疗预防PONV的实验技术被随机排列。在这些实验中使用的介入方法包括针灸,电针灸,经皮(皮下或者透皮?)神经刺激,激光刺激,辣椒涂覆,一个穴位刺激仪器,对手术中的患者进行穴位按压。主要的结果是恶心以及呕吐的风险。第二个结果是对于紧急止吐疗法的需求以及反效果。

两位综述作者独立的评估了实验的质量并且收集了数据。我们从这些实验中收集了反作用的数据。我们使用了随机效应模型并且报道了相对风险RR为95%的置信区间(95%CI)

主要的结果

这篇文章包含了40个实验共4858个参与者。其中4个实验报道了适当分配隐藏,12个实验并没有报道所有的结果。与安慰疗法相比,P6穴位刺激明显的减轻了恶心(RR 0.71 95% CI 0.61到0.83) 呕吐(RR 0.70, 95% CI 0.59 to 0.83),以及对于紧急止吐疗法的需求(RR 0.69, 95% CI 0.57 to 0.83)。不同实验之间的异质性非常温和(波动很小)。对于成人以及儿童进行的P6穴位刺激和安慰疗法对比并没有明显的差别。或者对于侵入性以及非侵入性穴位刺激也没有明显区别。并没有证据能够区分P6穴位刺激以及止吐药对于恶心 (RR 0.82, 95% CI 0.60 to 1.13), 呕吐 (RR 1.01, 95% CI 0.77 to 1.31)的效果,或者对于紧急制图要的需求 (RR 0.82, 95% CI 0.59 to 1.13)。 与P6穴位刺激相关的副作用非常小。没有证据表明有由轮廓增强的漏斗图导致的刊物倾向。

作者的结论:

P6穴位刺激能够预防术后恶心以及呕吐。迄今为止并没有可信的证据表明P6穴位刺激与止吐药相比,用于治疗术后恶心和呕吐时有风险区别。

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