本文關(guān)鍵詞： 針刺 預(yù)防 偏頭痛 系統(tǒng)評(píng)價(jià) 關(guān)聯(lián)分析　出處：《山東中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:運(yùn)用循證醫(yī)學(xué)系統(tǒng)評(píng)價(jià)的方法對(duì)針刺預(yù)防性治療偏頭痛的有效性和安全性進(jìn)行評(píng)價(jià);研究針刺預(yù)防性治療偏頭痛的選穴配伍規(guī)律。方法:根據(jù)Cochrane系統(tǒng)評(píng)價(jià)員手冊(cè)5.1.0制定文獻(xiàn)的納入與排除標(biāo)準(zhǔn)及檢索策略;對(duì)納入文獻(xiàn)進(jìn)行方法學(xué)質(zhì)量評(píng)價(jià);使用Revman5.3軟件對(duì)納入文獻(xiàn)進(jìn)行有效性及安全性評(píng)價(jià)的定量分析,采用有效率、每月偏頭痛發(fā)作天數(shù)、每月偏頭痛發(fā)作次數(shù)、偏頭痛疼痛程度、止痛藥物使用次數(shù)、每次偏頭痛平均持續(xù)時(shí)間、PDI、MIDAS、SF-36或SF-12作為結(jié)局指標(biāo)分別從0-1個(gè)月、1-2個(gè)月、3-4個(gè)月、5-6個(gè)月及6個(gè)月以上5個(gè)時(shí)間對(duì)有效性進(jìn)行評(píng)價(jià),采用不良反應(yīng)人數(shù)作為結(jié)局指標(biāo)對(duì)安全性進(jìn)行評(píng)價(jià)。計(jì)數(shù)資料采用相對(duì)危險(xiǎn)度(Relative Risk,RR)及其95%的可信區(qū)間(Confidence interval,CI);計(jì)量資料采用標(biāo)準(zhǔn)化均數(shù)差值(Standardized mean difference,SMD)及其95%可信區(qū)間;對(duì)不能進(jìn)行定量分析的指標(biāo)進(jìn)行定性分析。使用Access2013建立納入文獻(xiàn)選穴使用表,并使用SPSS Modeler14.1軟件對(duì)納入文獻(xiàn)資料進(jìn)行選穴配伍規(guī)律的關(guān)聯(lián)分析。結(jié)果:1.共檢索到文獻(xiàn)572篇,最終納入26個(gè)符合納入標(biāo)準(zhǔn)的研究文獻(xiàn),其中英文文獻(xiàn)15篇,中文文獻(xiàn)11篇(含學(xué)位論文4篇),共計(jì)納入受試者3657人。2.以對(duì)照組干預(yù)措施和時(shí)間段分亞組后,針刺與空白對(duì)照共計(jì)18個(gè)指標(biāo)有研究納入;與假針刺對(duì)照共計(jì)38個(gè)指標(biāo)有研究納入;與西藥對(duì)照共計(jì)34個(gè)指標(biāo)有研究納入。3.Meta分析結(jié)果顯示:與空白組對(duì)比,針刺預(yù)防性治療偏頭痛14個(gè)指標(biāo)顯示有效,4個(gè)指標(biāo)無(wú)明顯統(tǒng)計(jì)學(xué)差異;與假針刺對(duì)比,7個(gè)指標(biāo)針刺有效,2個(gè)指標(biāo)假針刺有效,其他29個(gè)指標(biāo)無(wú)明顯統(tǒng)計(jì)學(xué)差異;與西藥對(duì)比,22個(gè)指標(biāo)有效且安全性更高,12個(gè)指標(biāo)無(wú)明顯統(tǒng)計(jì)學(xué)差異。4.針刺預(yù)防性治療偏頭痛選用最多的3個(gè)穴位為風(fēng)池、率谷、太陽(yáng);共產(chǎn)生82條關(guān)聯(lián)規(guī)則,其中較為重要的規(guī)則有率谷→風(fēng)池、太陽(yáng)→風(fēng)池、太沖→風(fēng)池、太陽(yáng)+率谷→風(fēng)池、三陰交+風(fēng)池→太陽(yáng)、三陰交+太陽(yáng)→率谷、三陰交+太陽(yáng)+率谷→風(fēng)池、太沖+率谷+風(fēng)池→太陽(yáng)。結(jié)論:1.現(xiàn)有證據(jù)表明針刺預(yù)防性治療偏頭痛比空白對(duì)照有效,最差與西藥療效相當(dāng)且安全性更高。不足以證明與假針刺有療效差異。2.針刺預(yù)防性治療偏頭痛最常用的穴位為風(fēng)池、率谷、太陽(yáng),常與三陰交、太沖聯(lián)合使用。
[Abstract]:Objective: to evaluate the efficacy and safety of acupuncture in preventive treatment of migraine with the method of evidence-based medicine system evaluation. Methods: according to the Cochrane systematic evaluator's manual 5.1.0, the inclusion and exclusion criteria and retrieval strategy of the literature were formulated. Methodological quality evaluation of the literature included; Revman5.3 software was used to evaluate the efficacy and safety of the literature. The effective rate, the number of migraine attacks per month, the number of migraine attacks per month, and the degree of migraine pain were used. The average duration of each migraine was as follows: PDI MIDASS SF-36 or SF-12 were used as outcome indicators from 0-1 month to 1-2 months to 3-4 months, respectively. The effectiveness was evaluated for 5-6 months and more than 6 months. The safety was evaluated by the number of adverse reactions as the outcome index and the relative risk Risk was used to count the data. RR) and its confidence interval of 95%; The measured data were standardized mean difference (SD) and its 95% confidence interval. Qualitative analysis was carried out on the indexes which could not be quantitatively analyzed. Access2013 was used to set up the table of the use of the selected acupoints in the literature. SPSS Modeler14.1 software was used to analyze the law of acupoint compatibility. Results: 1. A total of 572 articles were retrieved. Finally, 26 research papers were included, of which 15 were in Chinese and English and 11 in Chinese (including 4 dissertations). A total of 3657 subjects were included. 2. After the intervention measures of control group and time period were divided into subgroups, 18 indexes of acupuncture and blank control were included in the study. A total of 38 indexes compared with pseudoacupuncture were included in the study. The results of meta-analysis showed that 14 indexes of acupuncture preventive treatment for migraine were effective compared with the blank group. There was no significant statistical difference among the four indexes. Compared with sham acupuncture, 7 indexes were effective, 2 indexes were effective, and the other 29 indexes had no significant difference. Compared with western medicine, 22 indexes were effective and the safety was higher. There was no significant difference in 12 indexes. 4. The three points of acupuncture preventive treatment for migraine were wind pond, rate valley and sun. A total of 82 association rules were generated, among which the more important ones were the rate Valley. 鈫扺ind pool, sun. 鈫扺ind tank, Taichung. 鈫扴olar rate valley. 鈫扺ind pool. 鈫扴un. 鈫扲ate valley. 鈫扺ind tank. 鈫扖onclusion 1. Available evidence suggests that acupuncture is more effective in preventive treatment of migraine than in blank control. The worst curative effect is comparable with western medicine and the safety is higher. It is not enough to prove that there is a difference between acupuncture and pseudoacupuncture. 2. The most commonly used acupoints for preventive treatment of migraine are Fengchi, rate Valley, Sun, and Sanyin. Combined use of Taichung.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.6

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