Intervention Review

Acupuncture for acute stroke

  1. Shihong Zhang1,
  2. Ming Liu1,*,
  3. Kjell Asplund2,
  4. Lin Li1

Editorial Group: Cochrane Stroke Group

Published Online: 20 APR 2005

Assessed as up-to-date: 10 NOV 2004

DOI: 10.1002/14651858.CD003317.pub2

How to Cite

Zhang S, Liu M, Asplund K, Li L. Acupuncture for acute stroke. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003317. DOI: 10.1002/14651858.CD003317.pub2.

Author Information

  1. 1

    West China Hospital, Sichuan University, Department of Neurology, Chengdu, Sichuan Province, China

  2. 2

    National Board of Health and Welfare, Socialstyrelsen, Stockholm, Sweden

*Ming Liu, Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan Province, 610041, China. wyplmh@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Acupuncture-like sensory stimulation activates multiple efferent (nerve) pathways leading to altered activity in numerous neural systems. Acupuncture is widely accepted by Chinese people and it is increasingly requested by patients and their relatives in Western countries.

Objectives

To assess the effectiveness and safety of acupuncture in patients with acute stroke.

Search methods

We searched the Cochrane Stroke Group trials register (last searched August 2003), the Chinese Stroke Trials Register (August 2003), the Chinese Acupuncture Trials Register (August 2003), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2003), MEDLINE (1966 to 2003), EMBASE (1980 to 2003), Alternative Medicine Database (1985 to 2003), CINAHL (1982 to 2003) and the Chinese Biological Medicine Database (1981 to 2003). Reference lists of systematic reviews and identified trials were handsearched.

Selection criteria

Randomised and quasi-randomised trials of acupuncture started within 30 days of stroke onset, compared with placebo/sham acupuncture or open control in patients with acute ischaemic and/or haemorrhagic stroke.

Data collection and analysis

Two reviewers selected trials for inclusion, assessed trial quality, and extracted the data independently. Authors of trials were contacted for missing data.

Main results

Fourteen trials involving 1208 patients were included. Ten trials included patients with only ischaemic stroke. When acupuncture was compared with sham acupuncture or open control, there was a borderline significant trend towards fewer patients being dead or dependent (Odds ratio (OR) 0.66, 95% confidence interval (CI) 0.43 to 0.99), and significantly fewer being dead or needing institutional care (OR 0.58, 95% CI 0.35 to 0.96) in the acupuncture group after three months or more. There was also a significant difference favouring acupuncture in the mean change of global neurological deficit score during the treatment period (standardized mean difference (SMD) 1.17, 95% CI 0.30 to 2.04). Comparison of acupuncture with sham acupuncture only showed a statistically significant difference on death or requiring institutional care (OR 0.49, 95% CI 0.25 to 0.96), but not on death or dependency (OR 0.67, 95% CI 0.40 to 1.12), or change of global neurological deficit score (SMD 0.01, 95% CI -0.55 to 0.57). Severe adverse events with acupuncture (dizziness, intolerable pain and infection of acupoints) were rare (6/386, 1.55%).

Authors' conclusions

Acupuncture appeared to be safe but without clear evidence of benefit. The number of patients is too small to be certain whether acupuncture is effective for treatment of acute ischaemic or haemorrhagic stroke. Larger, methodologically-sound trials are required.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Acupuncture for acute stroke

There is no clear evidence of benefit from acupuncture in acute stroke. In China, acupuncture is used to treat many acute and chronic conditions, including stroke. We reviewed evidence from randomised controlled trials investigating acupuncture in patients with acute stroke, to determine whether acupuncture was safe, and whether it could reduce the number of patients who died, or were left needing help with everyday activities. The review showed no clear effect of acupuncture on either outcome. Serious adverse effects were uncommon, and occurred in about one in every hundred patients treated. Results from much larger randomised trials are needed to assess accurately the benefits and harms of acupuncture in acute stroke.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針灸用於急性中風

針灸引起類似的感覺刺激能興奮很多傳出神經途徑,造成很多神經系統活性的改變. 針灸廣泛地為中國人所接受而在西方國家,它的使用也逐漸因病人和其家屬要求而增加

目標

評估針灸用於急性中風的效果和安全性

搜尋策略

我們搜尋了Cochrane Stroke Group trials register (搜尋至2003年8月), the Chinese Stroke Trials Register (搜尋至2003年8月) and the Chinese Acupuncture Trials Register (搜尋至2003年8月). 也搜尋了電子資料庫Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2003), MEDLINE (1966 to 2003), EMBASE (1980 to 2003), Alternative Medicine Database (1985 to 2003), CINAHL (1982 to 2003) and the Chinese Biological Medicine Database (1981 to 2003). 系統性回顧中的參考文獻及相關試驗都以手動方式搜尋

選擇標準

中風,急性梗塞性或出血性,在30天內開始的針灸,而對照組為安慰劑或模擬針炙療法或其他對照的隨機和quasirandomised試驗. 必須針刺入皮膚才算有效針灸

資料收集與分析

2位回顧者獨立地依選入標準選擇試驗並評估試驗品質和摘錄數據. 試驗者有被聯絡以取得未公佈的資料

主要結論

14個包含1208人的試驗被選取.10個試驗僅收納急性缺血性中風的病人. 針灸和安慰劑或模擬針炙療法或其他對照比較起來,只有稍微有較少死亡或殘障的趨勢(Odds ratio (OR) 0.66, 95% confidence interval (CI) 0.43 to 0.99),但3個月後接受針灸的病人有明顯較少的死亡或是需要機構照護(OR 0.58, 95% CI 0.35 to 0.96). 此外,接受針灸的病人在治療期間的整體神經功能缺陷分數上也有明顯改善(standardized mean difference (SMD) 1.17, 95% CI 0.30 to 2.04). 比較針灸與模擬針炙療法,僅在死亡或需要機構照護有顯著差異(OR 0.49, 95% CI 0.25 to 0.96),但對於死亡或殘障(OR 0.67, 95% CI 0.40 to 1.12),或整體神經功能缺陷分數並無差異(SMD 0.01, 95% CI −0.55 to 0.57). 嚴重的副作用如頭暈,無法忍受的疼痛或針灸處感染是罕見的(6/386, 1.55%).

作者結論

研究顯示針灸是安全的但是沒有明顯證據證明有效. 研究的病人數太少以致於無法判別對於治療缺血性或出血性中風是否有益. 大規模且有良好方法學的試驗是需要的

翻譯人

本摘要由奇美醫院何乘彰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前沒有證據證明針灸治療急性中風是有效的. 在中國,針灸早已被用來治療許多急性和慢性的疾病,包括中風. 我們回顧了一些研究針灸治療急性中風的隨機分配試驗,來評估安全性和是否能改善病人的死亡或生活獨立性. 結果顯示,針灸對於任一項?後沒有明顯幫助. 嚴重的副作用是少見的,機率大概1%. 我們需要更大型的隨機分配試驗來精確地評估針灸治療急性中風的效果和害處.