艾灸療法治療關節炎疼痛及關節活動度成效之系統性回顧與統合分析

人體的關節眾多，任何的關節都會因受傷導致慢性疼痛，其中又以負重關節膝、髖關節最容易受傷也最難痊癒。慢性疼痛通常以西醫的口服藥物、復健及手術療法來治療，但口服藥物可能會導致腸胃出血及不適，手術療法則可能引發後遺症，中醫的推拿、艾灸、拔罐輔助療法有助於減緩不適，艾灸不具侵入性且副作用少，可由護理人員獨立完成。本研究以系統文獻回顧暨統合分析方法討論艾灸對於關節炎的效益，系統性回顧使用Participants：「關節炎」(arthritis)，Interventions:「艾灸」(Moxibustion)；Outcomes:疼痛(pain)、關節活動度(range of motion)、Studies type: 「隨機控制試驗」(randomized control trial)，作為搜尋的關鍵字，搜尋年份起始時間為2011年7月至2018年12月，收錄於Cochrane Library、EBSCOhost (PubMed、CINAHL)、ProQuest、華藝中文電子期刊(CEPS)、臺灣博士論文知識加值資料庫、台灣期刊論文索引共六個中、英文電子資料庫進行搜尋，經篩選、評讀品質良好的文獻後，納入文獻六篇，利用Rev Man第五版的套裝軟體進行統合分析。結果顯示艾灸治療的關節炎疼痛與口服藥物相比達顯著效果，其綜合效果量3.74(95％信賴區間1.53~9.14，p = .04)，但艾灸治療關節炎關節活動度其效果尚未明確。建議艾灸療法用於關節炎病人的膝眼、梁丘、陽陵泉、血海、犢鼻等穴位，使用時間至少得六週。

關鍵字

艾灸療法；疼痛；關節活動度；系統文獻回顧；統合分析

並列摘要

There are many joints in human body. Joints may suffer from chronic pain due to injuries, among which the knee joint and hip joint can easily get injured and are hard to be healed. When it comes to chronic pain, we usually use western oral medicines, rehabilitation and surgeries to treat the problems. However, the oral medicines might result in gastrointestinal hemorrhage and discomfort, and the surgeries might cause complications. Massage, moxibustion and cupping therapy of Chinese medicine can be used to relieve the discomfort. Moxibustion is a non-invasive procedure with few side effects, and can be implemented independently by nurses. The effects of moxibustion for patients with arthritis were analyzed by systematic review and meta-analysis in this study. The searching keywords were ‘‘Participants: arthritis’’, ‘‘Interventions: moxibustion’’, ‘‘Outcomes: pain, range of motion’’, and ‘‘Study Type: randomized control trial’’. Six databases: Cochrane Library, EBSCOhost (PubMed, CINAHL), ProQuest, Chinese Electronic Periodical Services (CEPS), National Digital Library of Theses and Dissertations in Taiwan, and Taiwan Periodical Literature System were searched from July 2011 to December 2018. After appraising the methodological quality, six articles were conducted meta-analysis by RevMan 5. The results showed that the moxibustion is more effective to treat arthritis pain compared to the oral medicines. The effect size is 3.74 (95% CI: 1.53~9.14, p = .04). Nevertheless, moxibustion wasn’t proved helpful for improving the range of motion for arthritis. The moxibustion is suggested to use in Xiyan (EM 45), Liangqiu (ST 34), Yang Mound Spring (GB 34), Xuehai (SP 10) and Calf’s Nose (ST 35) as applying points, the treatment should last for at least six weeks for patients with arthritis