| Background:Chemotherapy,as one of the most important means in the comprehensive treatment of malignant tumors,plays a very far-reaching role in improving the quality of life of patients and prolonging the survival time of patients.However,chemotherapy is often accompanied by adverse reactions.Chemotherapy-induced nausea and vomiting(CfNV),as one of the most common adverse reactions of chemotherapy,seriously affects the choice of chemotherapy drugs,the dosage of chemotherapy drugs and the final chemotherapy cycle,ultimately leading to the reduction of chemotherapy efficacy and the impact on the survival time and quality of life of patients.Although western antiemetics have been used in CINV very maturely,they still have their limitations.At present,some studies show that acupuncture has its unique advantages in the treatment of chemotherapy-induced nausea and vomiting.The purpose of this study is to evaluate and analyze the therapeutic effect of acupuncture on CINV.Objective:Based on the principle of evidence-based medicine.according to the evaluation index provided by Cochrane Collaboration Network,meta-analysis is conducted on the current randomized controlled study on acupuncture treatment of CINV,and Meta analysis is conducted on cancer species.chemotherapy regimnen used and anti-emesis regimen to evaluate the effect of nausea and vomiting caused by acupuncture treatment of chemotherapy on improving symptoms of patients and improving quality of life of patients.Summarize and sort out the selection rules of acupuncture points and their commonly used acupuncture points,so as to provide evidence-based basis for the follow-up study to find the therapeutic effect of acupuncture on chemotherapy-induced nausea and vomiting.This paper analyzes the deficiencies in the current clinical trials in China and provides methodological basis for the clinical trials of acupuncture.Methods:Under the guidance of Cochrane's system evaluation manual,the standard of admission and discharge is established and a reasonable document retrieval strategy is designed.The retrieval of CNKI full-text database,VIP Chinese periodical database,Wanfang database.Chinese biomedical periodical citation database,PubMed,Web of Science,Ovid,Cochrane Library is all electronic.The time is before March 1,2020 when the database is built According to the title of the retrieved documents and the author,the repeatedly detected documents are screened out,and then the documents that do not meet the inclusion and exclusion criteria are excluded through abstracts and keywords to complete the initial screeningy of the detected documents.After reading the full text,the documents included in this analysis and evaluation were finally,selected.Inclusion criteria:(1)The original documents are published documents,and the experiment is designed as a randomized controlled or semi-randomized controlled experiment.The article should explicitly mention the words random,such as random grouping,random control,random number table,computer randomization,etc.,whether blind method is used or not.(2)The research object is malignant tumor chemotherapy patients with CINV,and the general situation is not limited.(3)Intervention measures:Acupuncture treatment group,combined with or without conventional anti-emetic scheme,while control group,with conventional anti-emetic scheme.(4)can obtain accurate data required for analysis,and has a clear therapeutic effect evaluation standard.(5)Chinese or English documents.Exclusion criteria:(1)No random control was set.(2)Self-cross control study.(3)Summary,experience summary,case study,discussion and meta-analysis.(4)Repeated publication or repeated detection of documents.(5)The curative effect evaluation is unclear or the curative effect has not been announced.(6)too few cases are included.(7)The full text cannot be obtained.(8)Research with unavailable or unclear outcome indicators.According to the bias risk assessment tool provided by Cochcrane collaboration network.the quality of the included documents was evaluated.The full text was read,and Microsoft Excel 2010 was used to establish a database to extract and input the included documents,including the author's name,year of study,place of case collection,age of participants,random method,blind method,total number of cases,number of lost cases,number of effective cases in observation group and control group,number of cases in observation group and control group,tumor type.chemotherapeutic drugs.antiemetic drugs,intervention methods,follow-up period,statistical processing method,and outcome indexRevMan5.3 software provided by Cochrane Collaboration Network was used for meta-analysis of the included literatures.Before analyzing the included study.the heterogeneity test(Q test)was carried out.The degree of heterogeneity was expressed by Higginse,12 and 12.Cochrane manual believed that when 12>50%,there was significant heterogeneity in the study.The results of this study are p<0.0001,I2=89%>50%,indicating significant heterogeneity in literature research.According to the results of heterogeneity test,random-effects models were used in the analysis,with OR and its 95%confidence interval as the effect quantity.In this study,the final results are represented by forest charts.When acupuncture is used as an intervention measure to improve the effectiveness of symptoms caused by chemotherapy.such as nausea and vomiting,if a dash line or diamond sign appears on the left side of the ineffective line,it indicates that the measure is effective.If a dash or diamond appears to the left of the vertical line,this means that the intervention is invalid.The existence of publication bias appears in the form of funnel plot.At the same time,data processing and analysis should be carried out for the subgroup included in the study,and the analysis results should be discussed and summarized.Results:A total of 1.356 articles were retrieved.including 1,249 Chinese databases,including 820 Chinese HowNet,172 Wanfang Medical Network and 252 VIP Chinese databases.After screening,13 articles were included.There were 107 English databases,all of which were excluded after screening.Therefore.a total of 19 studies(see Appendix 1)were included in this analysis and were all domestic studies.The screening flow chart is shown in Figure 1.In this study,1,467 cases were included in 19 literatures,with an age coverage of 18-75 years.735 cases in the experimental group and 732 cases in the control group.The experimental group is acupuncture or acupuncture-drug combination,while the control group is other therapies without any treatment in the experimental group.According to the evaluation tools recommended by Cochrane Collaboration Network,the quality bias of the included documents was evaluated methodologically.Evaluation tools include the following aspects:random method,allocation concealment,blind method for participants,blind method for experimenters,incomplete outcome data evaluation,selective reporting of outcome indicators,and other potential biases.According to the research results of all the included literatures,High Risk,Low Risk and Unclear Risk were evaluated for the above 7 aspects.Regarding the publication year of the included studies,the starting and ending time is from 1999 to 2019,specifically:there are 3 studies in 2019;Two studies were included in 2018;One study was included in 2017;Three studies were included in 2016 and two in 2015.There were two studies in 2013;There were two studies in 2012;There were two studies in 2008;One study was included in 2003 and one in 1999.No documents were included in 2014,2011,2010,2009 and 2007.Seven studies were gastrointestinal tumors(46.7%of the total number of studies);The three studies were multiple tumors,mainly lung cancer(accounting for 13.8%of the total number of studies);Three studies related to lung cancer(accounting for 11.9%of the total number of studies);The three studies were multiple tumors,and the specific tumor types were unknown(accounting for 12.3%of the total number of studies);Two studies related to hematological tumors(accounting for 11.0%of the total number of studies);One study concerned breast cancer(4.3%of the total number of studies).The 7 research chemotherapy regimens are oxaliplatin+calcium folinate+fluorouracil(46.7%of the total research),the 7 research chemotherapy regimens are mainly cisplatin(30.9%of the total research),1 research is mainly anthracyclines(5.4%of the total research population),another research is docetaxel and cyclophosphamide(4.3%of the total research population),and the remaining 3 studies are of unknown data(12.7%of the total research population).Granisetron was used as antiemetic in 7 studies(accounting for 36.0%of the total number of studies),metoclopramide was used as antiemetic in 5 studies(accounting for 31.5%of the total number of studies),ondansetron was used as antiemetic in 2 studies(accounting for 10.8%of the total number of studies),ondansetron was used as antiemetic in 2 studies(accounting for 9.4%of the total number of studies),tropisetron was used as antiemetic in 2 studies(accounting for 8.1%of the total number of studies at the station)and palonosetron was used as antiemetic in 1 study(accounting for 4.4%of the total number of studies)A total of 18 acupuncture points were involved in the 19 acupuncture prescriptions included in the study,with 735 times of acupuncture and 2326 times of acupuncture frequency.Acupoint selection is most common at Zusanli and Neiguan and the frequency of selection at Zusanli is 735 times(people),accounting for 100%of the usage frequency.Then there is the internal customs,634 times(people),accounting for 86.3%of the usage frequency.The second is Zhongwan 201 times(27.3%).Tian Shu 173 times(23.5%).Gongsun 101 times(13.7%),Geshu 53 times(7.2%).Pishu 52 times(7.2%),Moisture 41 times(5.6%).Guan Yuan 41 times(5.6%).Da Heng 41 times(5.6%),Taibai 37 times(5.0%),Yinlingquan 37 times(5.0%).Taichong 37 times(5.0%),Shangwan 31 times(4.2%).Sanyinjiao 30 times(4.2%),Weishu(4.2%),Yanglingquan 30 times(4.2%).Zhangmen 22 times(3.0%)Meta-analysis of 19 included literatures showed that due to p=0.31>0.05 and 12=12%,the fixed effect model was adopted,735 cases in the experimental group and 732 cases in the control group.the results showed that acupuncture could significantly improve nausea and vomiting caused by chemotherapy:RR=1.23,95%CI(1.17.1.29).p<0.00001.As for chemotherapy drug subgroup.cisplatin group(RR=1.25.95%CI[1.12.1.40],z=3.92,p<0.00001).oxaliplatin+calcium folinate+fluorouracil group(RR=1.17.95%CI[1.10.1.24],z=5.26,p<0.00001).the difference was statistically significant In anthracyclines group(RR=1.12.95%CI[0.96.1.30].Z=1.47.P=0.14),docetaxel group(RR=1.12.95%CI[0.89.1.40].Z=0.99.P=0.32),p>0.05,the difference was not statistical ly significant:no chemotherapy regimen data group(RR=3.52,95%CI[2.12.5.84],z=4.86.p<0.00001).Compared with antiemetic drugs(RR=1.18,95%CI[1.05.1.33].Z=268,P=0.007),p<0.05,indicating that acupuncture alone is more effective than antiem etic drugs.Compared with western medicine group,acupuncture combined with wester n medicine group(RR=1.24.95%CI[1.18,1.30],z=8.15.p<0.00001),p<0.05,the curative effect difference has statistical significance.The conclusion is that whether ac upuncture alone or on the basis of western antiemetic drugs,the effect of acupuncture plus acupuncture on CINV is stronger than that of western antiemetic drugs alone.Conclusion:According to the evaluation criteria of this analysis and Mate analysis,it is suggested that acupuncture has certain effect on nausea and vomiting caused by chemotherapy,which is worthy of further clinical research and test.However,acupuncture combined with western medicine anti-emesis scheme can obviously improve the anti-emesis therapeutic effect.Due to the inaccurate descriptions of random methods,blind methods and distribution concealment in the documents included in this study,the quality of the articles is reduced,and their credibility is obviously reduced.Bias exists among various studies,which makes the analysis results appear more optimistic than normal Meta,and the reliability of meta-analysis results is reduced. |
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