耳穴刺激对术前焦虑的疗效:一项随机对照临床试验的系统评价和Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：潘志军 编辑：张中伟 审校：曹莹
以前的随机对照试验（RCTs）表明，耳穴刺激（AS）治疗术前焦虑是安全有效的；但是，缺乏系统的评估。本研究目的是总结AS对术前焦虑以及其他结果的有效性和安全性的证据。
我们对RCTs进行了系统评价，包括来自所有效人群的患者。通过对从建立到2020年6月的MEDLINE（PubMed），EMBASE，Cochrane Central Register of Controlled Trials (CENTRAL)，ISI Web of Science和Scopus数据库进行搜索。研究选择和数据提取由2位独立评审员进行，能够解决第三作者的分歧。根据Cochrane 6.2,2021手册的建议进行Meta分析以及偏倚风险和证据质量评估。将AS与不同结果的药理学和非药理学干预进行了比较。评估了评估干预措施对焦虑评分的影响及其安全性，生理参数，围手术期药物需求和术后疼痛强度。
我们纳入了15项研究，共1603名患者。与对照组相比，AS表现出焦虑评分降低（标准化平均差（SMD）-0.72,95%置信区间（CI）-1.09至−0.36，p<0.0001；8项试验；701名患者；异质性：I2 80%；等级：中等确定性）；非干预组（SMD-1.01,95%CI-1.58至−0.45，p=0.0004；4项试验；420名患者；异质性：I2 84%；等级：非常低的确定性）。AS和苯二氮卓类药物之间没有差异（SMD-0.03；95%CI：−0.34至0.28；p=0.84；3项试验；158名患者；异质性：I2 0%；等级：非常低的确定性）。没有试验报告AS的严重不良反应。
AS可能有助于治疗术前焦虑。由于异质性质量对评估的影响，需要进一步的研究来阐明AS对术前焦虑的实际疗效。
Taras I. Usichenko, Kevin Hua , Mike Cummings ,et al.Auricular stimulation for preoperative anxiety - A systematic review and meta-analysis of randomized controlled clinical trials [J]. (J Clin Anesth 2022 02;76 ).
Auricular stimulation for preoperative anxiety - A systematic review and meta-analysis of randomized controlled clinical trials
Abstract
Study objective: Previous randomized controlled trials (RCTs) suggest that auricular stimulation (AS) is safe and effective in treatment of preoperative anxiety; however, a systematic evaluation is lacking. The aim was to summarize the evidence on efficacy and safety of AS for preoperative anxiety, as well as for other outcomes.
Design: We conducted a systematic review of RCTs including patients from all available populations. The search was done through MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and Scopus Database from inception to June 2020. Study selection and data extraction were performed in by 2 independent reviewers with ability to resolve disagreements by a third author. Meta-analyses as well as the risk of bias and evidence quality assessments were performed according to the Cochrane 6.2, 2021 handbook recommendations.
Interventions: We compared AS with pharmacological and non-pharmacological interventions for different outcomes.
Measurements: We assessed the repercussion of the evaluated interventions over anxiety scores and their safety, physiological parameters, perioperative medications requirement and intensity of postoperative pain.
Main results: We have included 15 studies with 1603 patients. AS has presented reduced anxiety scores as compared to the sham control (Standardized Mean Difference (SMD) -0.72, 95% confidence interval (CI) -1.09 to −0.36, p < 0.0001; 8 trials; 701 patients; heterogeneity: I2 80%; GRADE: moderate certainty) and to no intervention (SMD -1.01, 95% CI -1.58 to −0.45, p = 0.0004; 4 trials; 420 patients; heterogeneity: I2 84%; GRADE: very low certainty). There was no difference between AS and benzodiazepines (SMD -0.03; 95% CI: −0.34 to 0.28; p = 0.84; 3 trials; 158 patients; heterogeneity: I2 0%; GRADE: very low certainty). No trials reported serious adverse effects of AS.
Conclusions: AS may be useful in treatment of preoperative anxiety. Due to heterogenous certainty in effect estimates, further research is needed to clarify the actual efficacy of AS for preoperative anxiety.
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