| ObjectiveWith Cochrane systematic review method as the research method and acupoint as the entry point,traditional Chinese medicine(TCM)nursing techniques for diabetic peripheral neuropathy(DPN)was divided into three types according to different acting ways on acupoint: acupoint injection,acupoint massage,acupoint application.Relevant randomized controlled trial(RC T)were collected for systematic review,to analyze the effects of acupoint related TCM nursing techniques for four outcome indexes: DPN clinical total effective rate,sensory nerve conduction velocity,motor nerve conduction velocity and safety.MethodsInclusion and exclusion criteria of literatures were made according to “PICOS” factors and detailed search strategy was formulated.The Cochrane Library,Medline,Embase,AMED,CINAHL,C BM,CNKI,VIP,WanFang Data database were searched via computer and the expiration date of search was till April 2016.EndNote X7 software was used to manage literatures and remove the repeated literatures.Three researchers screened out literatures according to inclusion and exclusion criteria.Literature risk of bias assessment was carried out based on “risk of bias assessment standards” provided by Cochrane Collaboration and data extraction table was made to extract data.Finally,Revman5.3.5 software was adopted for Meta-analysis.In studies about acupoint injection for DPN,subgroup analysis was carried out based on the different injection of drugs to reduce clinical heterogeneity.ResultsSixty-nine studies were included,51 studies of acupoint injection,8 studies of acupoint massage and 10 studies of acupoint application.The risk of bias assessment were mostly unclear and the systematic review result is as follows:1.The clinical total effective rate:(1)51 studies reported the clinical total effective rate in the study of acupoint injection.Meta analysis showed that acupoint injection group was higher than the control group[O R=4.51,95%CI=(3.80,5.37),P<0.00001].Subgroup analysis was carried based on different injection drugs and results showed that the clinical total effective rate of mecobalamine acupoint injection group,C hinese medicine acupoint injection group,the B vitamins acupoint injection group and other drugs acupoint injection were higher than the control group.(2)8 studies reported the clinical total effective rate in the study of acupoint massage.Meta analysis showed that acupoint massage group was higher than the control group[OR=7.27,95%CI(4.44,11.90),P<0.00001].(3)9 studies reported the clinical total effective rate in the study of acupoint application.Meta analysis showed that acupoint application group was higher than the control group[OR=4.03,95%CI(2.64,6.17),P<0.00001].2.Sensory nerve conduction velocity:(1)10 studies reported sensory nerve conduction velocity improving condition of median nerve in the study of acpoint injection and meta analysis showed that the improvement of testing group was better than the control group[MD=4.06,95%CI(3.47,4.64),P<0.00001].5 studies reported SNCV improving condition of peroneal nerve and meta analysis showed that the improvement of testing group was better than the control group[MD=4.50,95%CI(3.13,5.87),P<0.00001].Subgroup analysis showed that SNCV of most acupoint injection groups was better than the control group.(2)2 studies reported SNCV improving condition of the left and right tibial nerve in the study of acupoint massage.Meta analysis showed that the difference between acupoint massage group and the control group had no statistical significance [MD=-1.72,95%CI(-5.42,1.99),P=0.36],[MD=1.49,95%CI(-0.43,3.40),P=0.13].(3)2 studies reported SNCV improving condition of the sural nerve in the study of acupoint application.Meta analysis showed that the improvement of testing group was better than the control group[MD=2.38,95%CI(1.19,3.57),P < 0.0001].3 studies reported SNCV improving condition of the median nerve.Meta analysis showed that the improvement of testing group was better than the control group[MD=1.17,95%CI(0.46,1.89),P=0.001].In descriptive analysis,SNCV improvement in tibial nerve of 2 studies were better than the control group.3.Motor nerve conduction velocity:(1)9 studies reported MNCV improving condition of peroneal nerve in the study of acupoint injection.Meta analysis showed that the improvement of testing group was better than the control group[MD=3.88,95%CI(2.32,5.44),P<0.00001].Subgroup analysis showed that MNCV of most acupoint injection groups was better than the control group.(2)2 studies reported MNCV improving condition of the left and right tibial in the study of acupoint massage.Meta analysis showed that the difference between acupoint massage group and the control group had no statistical significance [MD=1.21,95%CI(-1.07,3.48),P=0.30],[MD=1.41,95%CI(-0.33,3.14),P=0.11].(3)5 studies reported MNCV improving condition of peroneal nerve in the study of acupoint application.Meta analysis showed that the improvement of testing group was better than the control group[MD=2.47,95%CI(1.79,3.16),P < 0.00001].2 studies reported MNCV improving condition of superficial peroneal nerve.Meta analysis shows that he improvement of testing group was better than the control group[MD=2.49,95%CI(1.69,3.30),P<0.00001].4.Security: Six patients got pain and a part of patients got muscle sore or swollen in acupoint injection.Ten patients got skin redness,itching or rash symptoms in acupoint application.But these symptoms all gradually relieved or disappeared,no adverse reaction occurred in acupoint massage.ConclusionAcupoint related TCM nursing techniques(acupoint injection,acupoint massage,acupoint application)is an effective,safer caring technology for DPN patients.The clinical total effective rate,sensory and motor nerve conduction velocity of acupoint injection were higher than the control group and most indexes of subgroup analysis of different drugs were better than the control group.The clinical total effective rate of acupoint massage was higher than the control group,but it had no difference with control group in the improvement of sensory and motor nerve conduction velocity.The clinical total effective rate and sensory and motor nerve conduction velocity of acupoint application were higher than the control group.In safety assessment,six patients got pain and a part of patients got muscle sore or swollen in acupoint injection.Ten patients got skin redness,itching or rash symptoms in acupoint application.But these symptoms all gradually relieved or disappeared,no adverse reaction occurred in acupoint massage.Because the risk of bias assessments included in the studies are most unclear and there are few studies that include outcome indexes,so this study concluded should be taken prudently.In the future,we should develop high quality randomized controlled trials,regulate the report quality,and apply high quality evidences in clinical practices of DPN TCM nursing techniques.Meanwhile,TCM nursing techniques should be selected in accordance with patients' actual condition. |
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