非侵入性穴位療法改善透析病人尿毒搔癢成效之系統性文獻回顧暨統合分析

Systematic Review and Meta-Analysis of Non-Invasive Acupoint Therapy as an Approach to Urinary Itching Control in Dialysis Patients

10.6224/JN.202408_71(4).09

謝美玲(Mei-Ling HSIEH)；黃心樹(Hsin-Shu HUANG)；邱艶芬(Yann-Fen CHAO)；劉新莉(Hsin-Li LIU)

非侵入性穴位療法 ； 透析 ； 尿毒搔癢 ； 系統性文獻回顧 ； 統合分析 ； non-invasive acupoint therapy ； dialysis ； uremic pruritus ； systematic review ； meta-analysis

護理雜誌

71卷4期（2024 / 08 / 01）

69 - 80

繁體中文;英文

背景：尿毒搔癢是令透析病人非常痛苦的症狀之一，嚴重影響其生活品質與健康，導致其身心靈受損，更進而使住院率及死亡率增加，有需要發展具實證健康照護依據的多元療法，以使透析病人取得更方便可行的醫療資源。目的：統合國內外非侵入性穴位療法運用於改善透析病人之尿毒搔癢有效方式的相關研究，以協助臨床醫療人員能更有依據將非侵入性穴位療法運用在臨床實務。方法：PRISMA（preferred reporting items for systematic reviews and meta-analyses）系統文獻回顧和統合分析方法，搜尋2023年9月前發表於PubMed、Cochrane Library、Embase、Web of Science、華藝線上圖書館、臺灣博碩士論文知識加值系統、中國期刊全文數據庫及萬方數據知識服務平臺，以2019年隨機對照試驗之偏差風險工具第二版評讀研究品質，再以RevMan 5.4及Stata 14.0套裝軟體進行統合分析。結果：共搜集112篇文獻，最後納入9篇文獻（10組數據），有597名參與者進行分析。結果顯示非侵入性穴位療法可顯著降低透析病人尿毒搔癢程度，綜合效果量（standardized mean difference） = -1.30，95% confidence interval [-1.67, -0.93]，p < .00001。異質性檢定I^2 = 76%，顯示有高度異質性，故進行次群組分析，顯示穴位按摩配合中藥薰洗、一般簡易的搔癢評估量表及中國地區的綜合效果量較佳。結論／實務應用：非侵入性穴位療法具有操作簡單、價廉、無創和副作用少的特點，可加強透析病人對搔癢穴位的認知與實際操作手法，依本文獻回顧及統合分析結果顯示可在三陰交、血海和曲池穴位或耳穴的肺及內分泌穴位按摩，或按摩穴位配合中藥薰洗，也可運用紅外線照射三陰交或將經皮穴位電刺激於曲池穴，能達到改善尿毒搔癢程度之效果，而穴位按摩配合中藥薰洗是未來可向病人推薦的另一種方式。

Background: Uremic pruritus, one of the most painful symptoms experienced by patients receiving dialysis, seriously affects patient quality of life and health, causes physical and mental damage, and increases hospitalization and mortality rates. Multi-modal therapies with evidence-based healthcare are needed to provide patients receiving dialysis with more convenient and feasible medical resources. Purpose: Relevant domestic and international research on the effectiveness and methods of non-invasive acupoint therapy in improving uremic pruritus in dialysis patients was reviewed. Discussing related knowledge can facilitate the evidence-based use of non-invasive acupoint therapy in clinical practice by clinical medical personnel. Methods: Based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) systematic literature review and integrated analysis method, a keyword search of related articles published before September 2023 was conducted in the following databases: PubMed, Cochrane Library, Embase, Web of Science, Airiti Library, Taiwan Master and Doctoral Dissertation System, Chinese Journal Full-text Database and Wanfang Data Knowledge Service Platform. In 2019, the second version of the Risk of Bias Tool for Randomized Controlled Trials was used to evaluate research quality, after which RevMan 5.4 and Stata 14.0 suite software were used for meta-analysis. Results: Nine of the 112 articles selected, including 10 sets of data and 597 participants, were included in the meta-analysis. The results indicate non-invasive acupoint therapy significantly reduces the degree of uremic pruritus (synthetic effect size = -1.30, 95% confidence interval [-1.67, -0.93], p < .00001). Because the heterogeneity test I^2 = 76%, showed a high degree of heterogeneity, a subgroup analysis was performed, showing that acupoint massage combined with traditional Chinese medicine fumigation and washing, a general simple itching assessment scale, and the Chinese region achieved better effect sizes. Conclusions/ Implications for Practice: Non-invasive acupoint therapy is easy to implement, inexpensive, non-invasive, and associated with few side effects. The authors hope these findings may increase the awareness and understanding of patients with dialysis regarding the practical operation techniques of itching acupoints. According to the results of this systematic review and meta-analysis, massage of the lung and endocrine acupoints at ST-6, SP-10, and LI-11 as well as the relevant points on the ear may be most effective in achieving urinary itching relief. Also, acupoint massage combined with traditional Chinese medicine fumigation, ST-6 far-infrared irradiation, or LI11 transcutaneous acupoint electrical stimulation can further relieve uremic pruritus in this patient population. Based on the results, acupoint massage combined with traditional Chinese medicine fumigation and washing is a complementary method of treatment for uremic pruritus that may be recommended to patients in the future.

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