Acupuncture for acute stroke
Editorial Group: Cochrane Stroke Group
Published Online: 8 OCT 2008
Assessed as up-to-date: 10 NOV 2004
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: Edited (no change to conclusions)
- Published Online: 8 OCT 2008
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.
To assess the effectiveness and safety of acupuncture in patients with acute stroke.
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.
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.
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%).
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
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.
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
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%).
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
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
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.