推拿与蒙脱石散治疗小儿腹泻效果比较的Meta分析(1)
[摘要] 目的 比较推拿与蒙脱石散治疗小儿腹泻的效果。 方法 计算机检索CNKI、万方、维普、SinoMed、PubMed、Springer、Cochrane Library，检索年限为建库至2015年12月，纳入有关推拿治疗小儿腹泻的随机对照试验(RCTs)，由2名评价者独立进行文献筛选、资料提取并交叉核对纳入的研究质量，对纳入的同质研究采用RevMan 5.3进行Meta分析，质量评价则采用Cochrane系统评价员手册5.0版推荐的标准。 结果 共检索出2570篇，通过筛查最终纳入文献16篇，共1742例患者被纳入Meta分析。Meta分析结果显示在小儿腹泻的疗效方面推拿优于蒙脱石散，且差异有统计学意义(OR = 6.46，95%CI：4.16～10.04，P < 0.000 01)。 结论 推拿对小儿腹泻的疗效优于西药蒙脱石散。但由于纳入文献的质量评价等级较低，确切的结论仍需方法设计更为严谨的、大样本的随机对照实验来进一步验证。
[关键词] 推拿；蒙脱石散；小儿腹泻；随机对照试验；Meta分析
[中图分类号] R723.11 [文献标识码] A [文章编号] 1673-7210(2016)07(a)-0076-04
[Abstract] Objective To compare the therapeutic effect of massage with Montmorillonite Powder in treating infantile diarrhea. Methods All randomized controlled trials (RCTs) of massage therapy for infantile diarrhea were searched from CNKI， Wanfang， VIP， SinoMed， PubMed， Springer， Cochrane Library. Time was from inception to December 2015. According to inclusion and exclusion criteria， two reviewers independently selected and assessed the included trials. The Cochrane Collaboration Software RevMan 5.3 was used for Meta analysis and Cochrane Handbook for systematic reviews 5.0 was taken as a reference to quality evaluation of the included studies. Results A total of 2570 papers were searched. Finally 16 references， 1742 patients， were included in the Meta analysis through the screening. Meta analysis results showed that the efficacy of massage was superior to that of western medicine Montmorillonite Powder for infantile diarrhea， there was a statistically significant difference (OR = 6.46， 95%CI： 4.16-10.04， P < 0.000 01). Conclusion The efficacy of massage is superior to that of western medicine Montmorillonite Powder for infantile diarrhea. However， due to limited quantity of the included studies， the exact effect needs to be confirmed in well-designed and large-sampled clinical trials.
[Key words] Massage； Montmorillonite Powder； Infantile diarrhea； Randomized controlled trials； Meta analysis
小儿腹泻是婴幼儿中比较常见的疾病，一般多发生在6个月～2周岁的婴幼儿。腹泻是影响患儿生长发育的重要因素[1]。小儿腹泻的病原以及发病原因有很多，多是由细菌或病毒引起的，发病季节以夏季和秋季为主，临床表现为腹痛、呕吐、发热，伴大便次数增多，便质稀溏呈蛋花样或者水样，并含有未消化的乳食，常伴有黏液等。如果治疗不及时，容易导致脱水、电解质或酸碱失衡，甚至低血容量性休克或死亡[2]。关于小儿腹泻的西医治疗多为服用西药蒙脱石散。而小儿腹泻是小儿推拿治疗的优势病种之一，已有一些临床试验报道初步显示，推拿对小儿腹泻有较好的疗效，而且其安全舒适，容易被患儿所接受，但尚缺乏对于推拿与蒙脱石散间的疗效差异的相关证据评价，因此本研究收集相关资料，并依照循证医学的要求，以判断推拿与蒙脱石散相比是否能加强对小儿腹泻的疗效，为临床应用提供依据。
1 资料与方法
1.1 文献检索
通过计算机检索中国知网(CNKI)、万方、维普、SinoMed、PubMed、Springer、Cochrane Library等，收集国内外发表的涉及推拿治疗小儿腹泻的研究资料，检索年限为建库至2015年12月，检索的语言有汉语和英语，中文检索词有推拿、按摩，小儿、婴幼儿，腹泻、泄泻；英文检索词为manipulation、massage、tuina、nursling、infant、diarrhea。根据不同数据库的特征分别进行适用的检索途径，并追查所纳入的文献后附的参考文献，以尽可能多地收集相关文献，降低漏检的可能性。 (司梦冉 蔡君豪 王文奕 纪清)
[关键词] 推拿；蒙脱石散；小儿腹泻；随机对照试验；Meta分析
[中图分类号] R723.11 [文献标识码] A [文章编号] 1673-7210(2016)07(a)-0076-04
[Abstract] Objective To compare the therapeutic effect of massage with Montmorillonite Powder in treating infantile diarrhea. Methods All randomized controlled trials (RCTs) of massage therapy for infantile diarrhea were searched from CNKI， Wanfang， VIP， SinoMed， PubMed， Springer， Cochrane Library. Time was from inception to December 2015. According to inclusion and exclusion criteria， two reviewers independently selected and assessed the included trials. The Cochrane Collaboration Software RevMan 5.3 was used for Meta analysis and Cochrane Handbook for systematic reviews 5.0 was taken as a reference to quality evaluation of the included studies. Results A total of 2570 papers were searched. Finally 16 references， 1742 patients， were included in the Meta analysis through the screening. Meta analysis results showed that the efficacy of massage was superior to that of western medicine Montmorillonite Powder for infantile diarrhea， there was a statistically significant difference (OR = 6.46， 95%CI： 4.16-10.04， P < 0.000 01). Conclusion The efficacy of massage is superior to that of western medicine Montmorillonite Powder for infantile diarrhea. However， due to limited quantity of the included studies， the exact effect needs to be confirmed in well-designed and large-sampled clinical trials.
[Key words] Massage； Montmorillonite Powder； Infantile diarrhea； Randomized controlled trials； Meta analysis
小儿腹泻是婴幼儿中比较常见的疾病，一般多发生在6个月～2周岁的婴幼儿。腹泻是影响患儿生长发育的重要因素[1]。小儿腹泻的病原以及发病原因有很多，多是由细菌或病毒引起的，发病季节以夏季和秋季为主，临床表现为腹痛、呕吐、发热，伴大便次数增多，便质稀溏呈蛋花样或者水样，并含有未消化的乳食，常伴有黏液等。如果治疗不及时，容易导致脱水、电解质或酸碱失衡，甚至低血容量性休克或死亡[2]。关于小儿腹泻的西医治疗多为服用西药蒙脱石散。而小儿腹泻是小儿推拿治疗的优势病种之一，已有一些临床试验报道初步显示，推拿对小儿腹泻有较好的疗效，而且其安全舒适，容易被患儿所接受，但尚缺乏对于推拿与蒙脱石散间的疗效差异的相关证据评价，因此本研究收集相关资料，并依照循证医学的要求，以判断推拿与蒙脱石散相比是否能加强对小儿腹泻的疗效，为临床应用提供依据。
1 资料与方法
1.1 文献检索
通过计算机检索中国知网(CNKI)、万方、维普、SinoMed、PubMed、Springer、Cochrane Library等，收集国内外发表的涉及推拿治疗小儿腹泻的研究资料，检索年限为建库至2015年12月，检索的语言有汉语和英语，中文检索词有推拿、按摩，小儿、婴幼儿，腹泻、泄泻；英文检索词为manipulation、massage、tuina、nursling、infant、diarrhea。根据不同数据库的特征分别进行适用的检索途径，并追查所纳入的文献后附的参考文献，以尽可能多地收集相关文献，降低漏检的可能性。 (司梦冉 蔡君豪 王文奕 纪清)