- 期刊
穴位刺激措施改善中風住院病人之便秘：系統性回顧暨統合分析
Acupoint Stimulation Interventions Improve Constipation in Patients Hospitalized for Stroke: A Systematic Review and Meta-Analysis
摘要
急性期中風引起的便秘發生率為51%-68.2%，將嚴重影響中風之治療與預後。中醫穴位刺激對便秘改善雖有療效，但應用於住院中風病人，穴位選用及治療時間仍需進一步釐清。本研究目的乃運用系統性文獻回顧及統合分析確認穴位刺激於中風住院病人的便秘改善成效。本研究使用Pub Med、Ovid MEDLINE、Cochrane Library、EBSCO、Web of Science、華藝線上圖書館、中國知識資源總庫等七個中英文資料庫，搜尋住院中風便秘病人（P）、穴位刺激（I）、常規或藥物治療（C）、便秘改善成效（O）及隨機控制試驗（S）。文獻搜尋至2021年7月31日的隨機控制試驗研究。考科藍偏差風險評估工具用於研究品質的評估，CMAVersion2.2統計軟體用於統合分析。研究結果共納入20篇隨機控制試驗，1,780人。非侵入性介入措施包括耳穴按壓、穴位按摩及經皮穴位電刺激。總計使用22個體穴及13個耳穴，其中使用頻率最高的前六名依序為體穴之天樞（ST25）、中脘（RN12）、神闕（RN8）、長強（DU1）、關元（RN4）及大橫（SP15），耳穴之大腸（CO7）、三焦（CO17）、直腸（HX2）、肺（CO14）、小腸（MA-SC2）及脾（CO13）。穴位刺激可顯著改善中風住院病人的便秘（p＜.001）。穴位刺激時間介於3-28天，平均11.72天（SD=7.61）。穴位刺激時間次群組（3-7天、8-14天、15-28天）分析結果皆呈現顯著便秘改善成效（p＜.05）。本研究支持非侵入性穴位刺激介入措施對中風住院病人的便秘改善成效，單一或合併使用穴位刺激可依需求選用。建議臨床護理人員運用非侵入性穴位刺激輔助住院中風病人改善便秘問題，並選用可及的穴位。
並列摘要
The cumulative incidence of stroke-induced constipation is 51%-68.2% at the acute stage, which seriously affects the treatment and prognosis of stroke. Although evidence from systematic reviews has indicated that acupoint stimulation improves constipation, the proper acupuncture points must be identified for clinical application. The effects of acupoint stimulation on constipation for patients hospitalized for stroke were explored through a systematic review and meta-analysis. Seven electronic databases were used to identify studies published between the earliest year available and July 2021. Data on patients with stroke during hospitalization, acupoint stimulation interventions, routine care and medication, the clinical efficacy of acupuncture for constipation, and randomized controlled trials were collected. The Cochrane risk of bias tool was used to assess methodologic quality, and Comprehensive Meta-Analysis was used to analyze the data. A total of 20 articles were included, covering 1,780 patients. Noninvasive interventions involved auricular acupressure, acupressure, and transcutaneous acupoint electrical stimulation. A total of 22 bodily acupoints and 13 auricular acupoints were used. The six most frequently used somatic points, in descending order, were Tianshu (ST25), Zhongwan (RN12), Shenque (RN8), Changqiang (DU1), Guanyuan (RN4), and Daheng (SP15). Those of the auricular acupoints were Large Intestine (CO7), Sanjiao (CO17), Rectum (HX2), Lung (CO14), Small Intestine (MA-SC2), and Spleen (CO3). Acupoint stimulation had significant effects compared with routine care and medication (p ＜ .001). The intervention ranged from 3 to 28 days, with an average of 11.72 days (SD=7.61). Subgroup analysis demonstrated that three interventions of different durations had significant and positive effects (p ＜ .05). This indicates that noninvasive acupoint stimulation can improve constipation in patients hospitalized for stroke. Acupressure and auricular acupressure alone or in combination can be administered on the basis of the patient's needs. Clinical nurses should apply acupoint stimulation to the appropriate points as an adjuvant intervention to improve constipation in hospitalized patients with stroke.