| BackgroundPatients with immobilization caused by limb disorders or dysphagia in the sequelae stage of stroke are at high risk of occurrence of pneumonia,which are characterized by poor basic conditions,complex pathogens,numerous complications and high mortality.The conventional treatment means of western medicine is mainly anti-infection treatment,and the symptomatic treatment such as phlegm resolving and oxygen therapy is auxiliary,which has certain limitations in the control of infection and poor sputum discharge.Recently,the treatment of integrated traditional Chinese and western medicine has attracted more and more attention.Acupuncture and cupping are often used in the treatment of pneumonia respectively,which has the effect of anti-inflammatory,improving the clinical symptoms and signs related to pneumonia,shortening the course of disease and improving the prognosis.Therefore,this paper tries to explore the advantages of the combination of acupuncture and cupping as adjuvant treatment of patients with pneumonia complicated by sequelae of stroke stage.Purpose1.The data mining technology of modern literature was used to explore the rule of acupuncture and moxibustion in the treatment of SAP,so as to provide the basic rules of acupoints selection for acupuncture and moxibustion in the treatment of pneumonia on the sequelae stage of stroke.2.Systematic review and Meta-analysis was used to explore the clinical efficacy of cupping as adjuvant treatment of pneumonia,and the advantages and characteristics of cupping in the treatment of pneumonia were analyzed,so as to provide reference for the adjuvant treatment of cupping in the treatment of pneumonia on the sequelae stage of stroke.3.Randomized controlled clinical trial was conducted to compare acupuncture and cupping combined with western medicine and western medicine alone in order to observe the therapeutic effect of acupuncture and cupping combined as adjuvant therapy in patients with pneumonia on the sequelae stage of stroke,including the clinical symptoms and signs(especially in sputum excretion),blood inflammatory indexes,prognosis,etc.To provide an effective and feasible acupuncture and moxibustion treatment scheme for patients with pneumonia on the sequelae stage.Methods1.Analysis of the rules of acupuncture acupoints selection in the treatment of SAP.Four Chinese databases including CNKI,CBM,Wanfang and VIP,were searched from the establishment of the database to January 2021.Randomized controlled studies,clinical efficacy observation and cohort studies of acupuncture and moxibustion therapy in the treatment of SAP were included.Excel was used to establish acupuncture prescription database,and SPSS 26.0 and SPSS Modeler 18.0 were used for association analysis algorithm and cluster analysis.This study aims at exploring the rules of acupuncture and moxibustion therapy in the selection of acupoints in SAP.2.Systematic review and Meta-analysis of cupping as an adjuvant therapy for pneumoniaCNKI,Wanfong,CBM,VIP,PubMed,Embase,Web of Science,and Cochrane Libaray were searched from database establishment to February 2021 and included in related randomized controlled trial of cupping therapy as adjuvant treatment in pneumonia.Review Manager 5.3 was used for Meta-analysis to evaluate the effects of cupping on the clinical symptoms,signs,course of disease and effective rate of pneumonia patients.3.A randomized controlled study of combination of acupuncture and cupping of pneumonia on the sequelae stage of strokeA randomized controlled trial design was used to divide 61 patients with pneumonia on the sequelae stage of stroke into experimental group and control group according to the random number table.3.1 Treatment plan3.1.1 Control groupAccording to the Chinese Expert Consensus on the Diagnosis and Treatment of SAP(2019),western medicine treatment plan is formulated:the primary disease is actively treated;empirical antibiotics were used first and sensitive antibiotics were used instead after the bacterial culture and drug sensitivity test results;actively give resolution of phlegm,oxygen,antipyretic and other symptomatic treatment.7 days as 1course of treatment and 1 course of treatment was standardized.3.1.2 Experimental groupAcupuncture and cupping therapy were added on the basis of conventional western medicine treatment in the control group.Acupuncture:main acupoints are Feishu(BL13),Dazhui(GV14),Chize(LU5),Hegu(LI4)and Zusanli(ST36);Excess syndrome with Zhongwan(RN 12);Deficiency syndrome with Qihai(RN6).Fever with Yuji(LU10),abdominal distention constipation with Tianshu(ST25),sputum obstruction with Tiantu(RN22).Operation:The patient was placed in lateral decubitus position,and Feishu(BL13)and Dazhui(GV14)were performed without needle retention.Then took supine position and stimulated next three acupoints.After the acupoints get qi,applied with the technique of reinforcing and reducing for 30 seconds,and keep it for 15-20 minutes.Cupping therapy:Dazhui(GV14),Fengmen(BL12),Feishu(BL13)and local acupoints according to the chest rales.Operation:The patient was placed in the lateral position,and the back was fully exposed.First,the pot was shimmer in the upper back and the parts with more rales detected by auscultation,and then the pot was left in the selected acupoints for 5 minutes with moderate strength to make the skin bulge in the pot about 1-2mm,which should not be excessively aspirated.Acupuncture and cupping were treated once a day,7 days as a course of treatment and 1 course of treatment in total.3.2 Assessment3.2.1 The primary observation indexes and evaluation time pointsSputum excretion score:sputum quality and sputum discharge volume.Evaluation time point:Daily monitoring was performed duiring the treatment course and compare the data on the time point of before treatment,the 3rd day and the 7th day of treatment.3.2.2 Secondary observation indexes and evaluation time pointsIncluding WBC,NE%,CRP in the blood,clinical pneumonia infection score(CPIS),TCM syndrome scale score,and mortality on day 14th and 28th.Evaluation time point:Laboratory indicators,CPIS and TCM syndrome scale score were evaluated before treatment,on the 3rd day and the 7th day after treatment.Mortality was evaluated with follow-up records at 14th and 28th days after treatment.Results1.Literature research 11.1 Literature inclusionA total of 4276 literatures were retrieved,and 2740 literatures were left after rechecking.Finally,44 literatures were included.A total of 51 groups of acupoint prescriptions were extracted,82 acupoints were involved in with a total frequency of 340 times.1.2 Result analysisThe rules for aucpoints selection for the treatment of SAP are as follows:the most selected points were bladder meridian of foot-taiyang,stomach meridian of foot-yangming,large intestine meridian of hand-yangming and lung meridian of hand-taiyin.Acupoints were mainly selected on the back and limbs.Wushu acupoints,confluent points,back-shu points and luo points were commonly used.According to the association rules,the core point pair was analyzed as Quchi(LI11)-Zusanli(ST36)-Hegu(LI4).According to cluster analysis,it can be divided into three categories:Zusanli(ST36),Quchi(LI11),Hegu(LI4),Taichong(LR3)and Fenglong(ST40);Lieque(LU7),Zhongfu(LU1),Fengfu(GV16);Pishu(BL20),Shenshu(BL23),Feishu(BL13)and Dazhui(GV14).2.Literature research 22.1 Literature inclusionA total of 714 literatures were retrieved according to the retrieval strategy,and 13 literatures were finally included for Meta-analysis.Published from 2007 to 2020,all were randomized controlled trials published in Chinese journals.The intervention measures were simple cupping plus western medicine treatment and western medicine control.The subjects of 9 studies were children,and the remaining 4 were adults,mostly middle-aged and elderly.2.2 Result analysisMeta-analysis results showed that the total effective rate in the experimental group was higher than that in the control group,with statistical significance[RR=1.19,95%CI(1.14,1.24),P<0.00001].Compared with the control group,the adjuvant therapy of cupping reduced the time of fever,disappearance of cough and length of hospitalization[MD=-0.46 day,95%CI(-0.68,-0.24),P=0.0005;MD=-1.86 days,95%CI(-2.05,-1.67),P<0.00001;MD=-1.00 day,95%CI(-1.13,-0.87),P<0.00001].Qualitative analysis showed that compared with the control group,the experimental group could shorten the disappearance time of lung rales and improve the pulmonary signs.3.Clinical research3.1 Sputum dischargeComparison in the sputum discharge score:the sputum discharge scores in the two groups were significantly lower than that before treatment(P<0.01 in the experimental group,P<0.05 in the control group).Comparison between two groups:there were significant difference between the two groups on the 3rd and 7th day of treatment(P<0.05).The difference between the two groups on the 3rd day of treatment and before treatment,the 7th day of treatment and before treatment,and the 7th day of treatment and the 3rd day of treatment were statistically significant(P<0.05).In the sputum property score,comparison within the groups:the two groups after treatment were significantly lower than that before treatment(experimental group P<0.01,control group P<0.05).Comparison between groups:There was no difference between groups on the 3rd day of treatment(P>0.05),but there was difference between groups on the 7th day of treatment(P<0.05).The differences between the two groups on the 3rd and 7th day of treatment and before treatment were statistically significant(P<0.01).The scores of sputum excretion in the experimental group on the 3rd and 7th day of treatment were significantly lower than those before treatment,and the 7th day of treatment was lower than that on the 3rd day of treatment(P<0.01).In the control group,it was lower on 7th day of treatment than before treatment(P<0.05).Comparison between two groups:there were significant differences between two groups on the 3rd day and the 7th day of treatment(P<0.05).The pairwise difference between the two groups at each evaluation time point was statistically significant(P<0.05).3.2 Inflammatory indexes of bloodWBC in the experimental group was significantly lower than that before treatment on the 3rd and 7th day of treatment(P<0.01).In the control group,there was no difference on the 3rd day of treatment compared with before treatment(P>0.05),but difference on the 7th day of treatment compared with before treatment and the 3rd day of treatment respectively(P<0.05).Comparison between two groups:After treatment,there was no statistical significance between the two groups on the 3rd and 7th day of treatment(P>0.05).The difference on the 3rd day of treatment compared with that before treatment was statistically significant(P<0.05).NE%in the experimental group,both on the 7th and 3rd day of treatment was significantly lower than that before treatment(P<0.01),and the 7th day of treatment was lower than that on the 3rd day of treatment(P<0.01).The control group was lower on day 7 than before treatment(P<0.05).Comparison between groups:After treatment,there was no statistical difference between the two groups on the 3rd and 7th day of treatment(P>0.05).Moreover,there was no statistical significance in the pairwise difference between the two groups at each time point(P>0.05).CRP in the treatment group on 7th day and 3rd day was significantly lower than that before treatment,and in the exprimental group on 7th day was significantly lower than that on 3rd day(P<0.05);The control group on 7th day was significantly lower than before treatment(P<0.05).Comparison between groups:there was no difference on the 3rd day of treatment(P>0.05),and there was statistically significant difference on the 7th day of treatment(P<0.05).The difference between the two groups on 3rd day and 7th day of treatment and before treatment was statistically significant(P<0.01).3.3 CPISWithin group comparison:CPIS in the two groups were significantly decreased after treatment(P<0.01 in the experimental group,P<0.05 in the control group).Comparison between two groups:There was no difference between the two groups on the 3rd day of treatment(P>0.05),and the comparison on the 7th day of treatment was statistically significant(P<0.05).There was no statistical significance in the pairwise difference between the two groups at each evaluation point(P>0.05).3.4 Score of TCM syndrome scaleWithin group comparison:the two groups after treatment was significantly lower than before treatment(P<0.01).Comparison between groups:There was statistical significance between the two groups on the 3rd and 7th day of treatment(P<0.01).The difference between the two groups on day 3 and day 7 of treatment and before treatment was statistically significant(P<0.01).3.5 Mortality at 14 and 28 daysChi-square test showed no significant difference in mortality rate between 2 groups on the 14th and 28th day(P>0.05).Conclusion1.Literature research 1 suggests that acupuncture and moxibustion treatment of stroke-related pneumonia pays attention to the selection of proximal acupoints,meridian selection of distant;Yang meridian is used mostly;emphasize the use of specific points;the basic acupoint prescription is "Quchi(LI11)-Zusanli(ST36)-Hegu(LI4)".2.Literature research 2 suggested that cupping as an adjuvant treatment of pneumonia could shorten the time for patients to abate fever,the disappearance time for symptoms such as cough,sputum and lung rales and the length of hospital stay,and improve the clinical effectiveness without the occurrence of adverse reactions.3.Clinical research shows that the combination of acupuncture and cupping as adjuvant treatment of pneumonia on the sequelae stage of stroke can improve the clinical symptoms and signs of pneumonia,especially in improving sputum properties and sputum volume in the comparation with western medicine alone.It can reduce the level of CRP in the blood and reduce inflammation. |
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